Femoral Neck System

Surgical Technique
Image intensifier control

This description alone does not provide sufficient background for direct use
of DePuy Synthes products. Instruction by a surgeon experienced in handling
these products is highly recommended.

Processing, Reprocessing, Care and Maintenance

For general guidelines, function control and dismantling of m ­ ulti-part
instruments, as well as processing guidelines for i­mplants, please contact your
local sales representative or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
For general information about reprocessing, care and maintenance of Synthes
reusable devices, instrument trays and cases, as well as processing of Synthes
non-sterile implants, please consult the Important Information leaflet
(SE_023827) or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
Table of Contents

Introduction AO Principles 2

Intended Use, Indications and

Contraindications, Adverse Events 3

MRI Information 4

System Highlights6

Surgical Technique Preparation8

Implant Insertion 11

Antirotation-Screw and Locking Screw Insertion 20

Option: Intra-Operative Compression 27

Instrument Disassembly and Final Check 30

Option: Implant Removal 32

Checking Fixation Sleeve Wear 35

Product Information Implants36

Instruments41

Surgical Technique Femoral Neck System DePuy Synthes 1

AO Principles
AO PRINCIPLES

In 1958, the AO formulated four basic principles, which

In 1958,
have the AO
become theformulated
guidelinesfour basic principles,
for internal fixation1,2which
.
have become the guidelines for internal fixation1, 2.

4_Priciples_03.pdf 1 05.07.12 12:08

Anatomic reduction
reduction Stable
Stable fixation
fixation
Fracture reduction
reduction and
and fixation
fixation to Fracture
Fracture fixation
fixationproviding
providingabso-
absolute
restore
to anatomical
restore relationships.
anatomical relation- lute or relative
or relative stability,
stability, as
as required by
ships. required by the patient, the injury,
the patient, the injury, and the per-
1 2 and the personality
sonality of the
of the fracture.
fracture.

Early, active
active mobilization
mobilization Preservationof
Preservation ofblood
bloodsupply
supply
safe mobilization
Early and safe mobilization and
and 4 3 Preservation of the bloodsupply
Preservation of the blood supply
rehabilitation of
of the
the injured
injured part
part to
to soft
soft tissues
tissues and
andbone
bonebyby gentle
and the patient
patient as
as aa whole.
whole. gentle reduction
reduction techniques
techniques and
and careful
careful
handling.handling.

1
Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal
Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.
2
Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management.
2nd ed. Stuttgart, New York: Thieme. 2007.

1 M üllerME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation.

3rd ed. Berlin, Heidelberg, New York: Springer. 1991.
2 Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed.

Stuttgart, New York: Thieme. 2007.

4
2 DePuy
DePuy Synthes
Synthes Expert
FemoralLateral
Neck Femoral
System Nail Surgical
Surgical Technique
Technique
Intended Use, Indications and
Contraindications, Adverse Events

Intended Use
The Femoral Neck System (FNS) is intended for tempo-
rary fixation, correction or stabilization of bones in the
femoral neck.

Indications
• Femoral neck fractures (AO type 31-B)

Contraindications
• Pertrochanteric fractures (AO type 31-A1 and 31-A2)
• Intertrochanteric fractures (AO type 31-A3)
• Subtrochanteric fractures

Additionally, this system should not be used for cases

where there is a high incidence of:
• Sepsis
• Malignant primary or metastatic tumors
• Material sensitivity
• Compromised vascularity

Adverse Events
As with all major surgical procedures, risks, side effects
and adverse events can occur. While many possible
reactions may occur, some of the most common include:
Problems resulting from anesthesia and patient position-
ing (e.g. nausea, vomiting, dental injuries, neurological
impairments, etc.), thrombosis, embolism, infection,
excessive bleeding, iatrogenic neural and vascular injury,
damage to soft tissues incl. swelling, abnormal scar
formation, functional impairment of the musculoskeletal
system, Sudeck’s disease, allergy/hypersensitivity reac-
tions and side effects associated with hardware promi-
nence, malunion, non-union, device breakage, device
loosening. Additional device specific adverse events that
may occur: Pain, device migration (e.g. wire migration
and penetration into the pelvic cavities), bone damage
and bone fracture.

Surgical Technique Femoral Neck System DePuy Synthes 1

MRI Information

Torque, Displacement and Image Artifacts according to

ASTM F 2213-06(2011), ASTM F 2052-14 and ASTM
F 2119-07(2013)
Non-clinical testing of worst case scenario in a 3 T MRI
system did not reveal any relevant torque or displacement of
the construct for an experimentally measured local spatial
gradient of the magnetic field of 30 T/m. The largest image
artifact extended approximately 25 mm from the construct
when scanned using the Gradient Echo (GE). Testing was
conducted on a 3 T MRI system.

Radio-Frequency-(RF-)induced heating according to

ASTM F 2182-11a
Non-clinical testing of worst case scenario lead to tempera-
ture rises of 6.6°C (1.5 T) and 9.2°C (3 T) under MRI Condi-
tions using RF Coils (whole body averaged specific absorp-
tion rate [SAR] of 2 W/kg for 15 minutes).

Precautions: The above mentioned test relies on non-

clinical testing. The actual temperature rise in the pa-
tient will depend on a variety of factors beyond the
specific absorption rate (SAR) and time of RF applica-
tion. Thus, it is recommended to pay particular atten-
tion to the following points:
• It is recommended to thoroughly monitor patients un-
dergoing MR scanning for perceived temperature
and/or pain sensations.
• Patients with impaired thermoregulation or tempera-
ture sensation should be excluded from MR scanning
procedures.
• Generally, it is recommended to use a MR system
with low field strength in the presence of conductive
implants. The employed specific absorption rate
(SAR) should be reduced as far as possible.
• Using the ventilation system may further contribute
to reduce temperature increase in the body.

4 DePuy Synthes Femoral Neck System Surgical Technique

System Highlights

The Femoral Neck System (FNS) is a dedicated product Bolt

for the fixation of femoral neck fractures and offers the • Provides angular stability (fixed a­ ngle
following features: between Bolt and ARScrew)
• Dynamic design (Bolt and ARScrew
slide together over a distance of
20 mm)
• Designed to reduce lateral protrusion
Antirotation-Screw (ARScrew)
• Provides rotational stability (diverging
design between ARScrew and Bolt)
• Allows implant placement even in
a small femoral neck

Product Offering
• Material: TAN (Ti-6Al-7Nb)
• Construct Sizes: 75 mm to 130 mm
(5 mm increments)
• 1-hole plate with 130° angle
(2-hole plate optionally available)

Sterile Packaging
• Implant Kit packaging
• Plate, Bolt and ARScrew
packaged in one kit
• Reduced storage space
• Reduced packaging waste
• Also available in single packaging

Plate (with Locking Screw)

• Provides angular stability
(fixed angle between Bolt and ARScrew)
• Accommodates standard 5.0 mm Locking Screws
• Designed to provide optimal implant footprint

6 DePuy Synthes Femoral Neck System Surgical Technique

 Surgical Step Etchings
• The main instruments are etched with letters
and arrows to facilitate the surgical procedure
• Corresponding letters are highlighted in this
­surgical technique

Protection Sleeve
• Used to insert Locking Screws
• Helps to protect soft tissue

Insertion Handle
• Serves as handle for entire system
• Used to insert Plate and Bolt
• Allows to guide additional wires

Insert for Insertion Handle

• Serves as guide to insert
the ARScrew
• Allows intra-operative com-
pression (in combination with
the Multifunction Rod)

Surgical Technique Femoral Neck System DePuy Synthes 7

Preparation

1. Position Patient 1

Place the patient in a supine position on the operating

table.

Position the image intensifier to enable visualization of

the proximal femur in both the AP and lateral planes. (1)

1 DePuy Synthes Femoral Neck System Surgical Technique

2. Reduce Fracture

Before Reduction
Instrument

357.399* Guide Wire B 3.2 mm, length 400 mm

or
356.830* Guide Wire B 3.2 mm, for PFNA Blade

Note: Proper reduction of the fracture is crucial for

good bone healing and function as well as reduction
of complications. After Reduction

Reduce the fracture by means of gentle traction/flexion,

adduction/abduction and internal rotation (about 15°, so
the femoral neck is parallel to the operating table).

Check the reduction in two planes under image intensi-

fier control. If the reduction is insufficient consider open
reduction.

Insert an unused wire as antirotation wire in the supe-

Temp. Fixation

rior/anterior part of the femoral neck to prevent any in-

advertent rotation of the femoral head.

Notes:
• An inappropriate position of the antirotation wire
may interfere with the proper placement of the im-
plant.
• The antirotation wire can be placed percutaneous
or through the lateral incision (see page 7).

Precaution: Monitor the position of the wire during

insertion and confirm the final position using the
image intensifier. Over inserting guide wires could
lead to damage to vital organs.

* Available non-sterile and sterile packed. Add “S” to the article number to
order sterile products.

Surgical Technique Femoral Neck System DePuy Synthes 9

Preparation

3. Approach 1

Make a straight lateral skin incision of approximately

6 cm in length, starting 2 to 3 cm proximal to the center
of the femoral neck axis. (1)

Access and expose the lateral femoral surface accord-

ingly for satisfactory hardware placement.

Option:
In obese patients, consider making a second incision
during locking screw insertion. The second incision
needs to be at the entry point of the protection sleeve,
proximal to the main incision (see pages 18 and 19 for
additional information on attaching the protection
sleeve).

12 DePuy Synthes Femoral Neck System Surgical Technique

Implant Insertion

Irrigate and apply suction for removal of debris poten-

tially generated during implant insertion. 1

1. Insert Guide Wire

Instruments

re
Wi
ion
357.399* Guide Wire B 3.2 mm, length 400 mm

t at
t iro
or

An
356.830* Guide Wire B 3.2 mm, for PFNA Blade

03.168.001 Angled Guide 130°, for Guide Wires

Cental Guide Wire

B 3.2 mm

Insert a second, unused guide wire as central guide wire,

using the 130° angled guide. (1)

Use image intensification to place the guide wire slightly

inferior to the apex of the femoral head, extending into
the subchondral bone on the AP view. (2)
2
In the lateral view, the guide wire should be central in
the femoral neck and head. (3)

Note: The position of the guide wire within the fem-

oral neck and head should be chosen according to
the patients anatomy before fracture. The implant
plate allows a placement of about ±5° compared to
the 130° angle.

Precautions:
3
• Monitor the position of the wire during insertion
and confirm the final position using the image
­intensifier. Over inserting guide wires could lead
to damage to vital organs.
• Replace wires if they are bent after insertion.

* Available non-sterile and sterile packed. Add “S” to the article number to
order sterile products.

Surgical Technique Femoral Neck System DePuy Synthes 11

Implant Insertion

2. Option: Adjust Guide Wire 1. Example:

Parallel correction
Instruments with new entry
point anterior.
357.399* Guide Wire B 3.2 mm, length 400 mm
or
356.830* Guide Wire B 3.2 mm, for PFNA Blade

03.168.002 Correction Guide, for Guide Wires

Parallel Wire – new entry point

B 3.2 mm (optional)

Use the correction guide and an unused guide wire to

adjust the position of the central guide wire in reference
to the initial central guide wire. The following three
types of adjustments are possible:

anterior
1. Parallel Correction (5 mm)

Insert the correction guide over the initial wire

(orange) and turn the correction guide to define the
new entry point (anterior/posterior or inferior/supe-
rior). Then use a new wire in the parallel hole (green)
and remove the initial wire.
2. Example:
2. Angle Correction (5°) and Entry Point Correction Angle correction
(5 mm) towards anterior
with new entry
Insert the correction guide over the initial wire point superior.
(orange) and turn the correction guide to define the
new entry point. Then use a new wire in either the
left or the right 5°-hole (green).

Wire towards an-

terior – new en-
try point superior

* Available non-sterile and sterile packed. Add “S” to the article number to
order sterile products.

11 DePuy Synthes Femoral Neck System Surgical Technique

3. Angle Correction (5°) and Same Entry Point
3. Example:
Insert the correction guide over the initial wire Angle correction
(orange hole in side-view), turn the correction guide towards anterior
to choose the new temporary entry point, insert a with same entry
new wire in the parallel hole (blue) and remove the point. Initial wire
initial wire. Then use a new wire in either the left or (orange) only
the right 5°-hole (green) to correct the angle. shown in side-
view).
Precautions:
• Monitor the position of the wire during insertion
and confirm the final position using the image
­intensifier. Over inserting guide wires could lead
to damage to vital organs.
• Replace wires if they are bent after insertion.

Wire towards
anterior – same
entry point

Surgical Technique Femoral Neck System DePuy Synthes 11

Implant Insertion

3. Determine Length 1

Instrument

03.168.003 Direct Measuring Device, for Guide

Wires B 3.2 mm

Slide the direct measuring device over the central guide

wire. (1)

re
Wi
ion
Read the depth of the guide wire on the direct measur-

t at
ing device. (2)
t iro
An

As the guide wire is inserted into the subchondral bone

(in the AP view), remove 5 mm from the value seen on
the direct measuring device and choose the next shorter
construct size.

The available construct sizes are:

75 mm   95 mm 115 mm
2
80 mm 100 mm 120 mm
85 mm 105 mm 125 mm
90 mm 110 mm 130 mm

Example: If you read 102 mm on the direct measur-

ing device, the construct size of the implant should
be 95 mm (102 – 5 = 97 choose 95 mm).

11 DePuy Synthes Femoral Neck System Surgical Technique

4. R
 eam for Insertion of Plate and 1
1
Bolt

Instrument

03.168.004 Reamer, complete

Consisting of:

03.168.005 Drill Bit B 10.2 mm, cannulated,

length 251 mm

03.168.006 Reamer B 12.5 mm

2
03.168.007 Nut, for Reamer

3
Assemble the reamer by sliding the reamer-component
over the drill bit until it clicks into place at the selected
construct size (95 mm in the example before). Secure the
reamer by tightening the nut. (1)

Surgical Technique Femoral Neck System DePuy Synthes 11

Implant Insertion

Ream down until the reamer stops on the bone. (2)

2
Notes:
• It is recommended that the femoral head is tempo-
rarily fixated with an antirotation wire prior to
reaming.
• Control guide wire migration and check reaming
depth during reaming using the image intensifier.

re
Wi
• When reaming in dense bone, use of continuous ir-

ion
rigation is recommended.

t at
t iro
• Avoid excessive reaming force during reaming.

An
Remove the reamer.

It is important to reinsert the guide wire if it is removed

accidentally. To reinsert the wire push the reamer back
into the reamed hole (without the use of a power tool)
and use the cannulation to reinsert the guide wire into
the original position.

11 DePuy Synthes Femoral Neck System Surgical Technique

5. A
 ssemble Implant and Insertion 1
Instruments

Instruments

03.168.008 Insertion Handle

03.168.009 Insert, for Insertion Handle A

A Slide the insert into the insertion handle, without

tightening the black screw. (1)

Fully insert the bolt with the selected construct size

(95 mm in the example before) into the plate. (2)

B Mount the implant onto the insertion handle. (3)

2
Note: Ensure that the implant is correctly fixed to
the insertion instrument and that the bolt is in the
completely extended position.

C Manually tighten the black screw of the insert to

attach the implant. (4)

Precaution: Hand-tightening the black screw is

sufficient. Using additional tools might cause
overtightening.

Option: A longer side plate with two locking holes

(2-hole plate) is available as option.

Surgical Technique Femoral Neck System DePuy Synthes 11

Implant Insertion

6. Insert Implant 1

Instrument

03.168.015 Cylinder, for Insertion Instruments

(optional)

re
Insert the implant over the central guide wire into the

Wi
ion
pre-reamed hole. (1)

t at
t iro
An
Precaution: When not using the cylinder, the guide
wire will become visible on the outer side of the
insert. Ensure not to move the guide wire. (2)

Option:
The cylinder can be used to manually tap the plate onto
the bone. (3) If additional tapping is required, use 2
a standard surgical hammer to slightly tap onto the
cylinder.

Use image intensification to confirm the insertion depth

and ensure that the plate is inserted down to the bone
as well as aligned with the axis of the femoral shaft. (4)
re
Wi

Notes:
ion
t at

• It is recommended that the femoral head is tempo-

t iro

rarily fixated with an antirotation wire prior to

An

implant insertion.
• Avoid excessive insertion force.
• After insertion, ensure that the instruments are
still correctly fixed to the implant.

4 4 3
re
Wi
ion
t at
t iro
An

11 DePuy Synthes Femoral Neck System Surgical Technique

7. Remove Guide Wire 1

Remove the central guide wire. (1)

Keep the antirotation wire to prevent loss of reduction

and rotation of the head.

re
Wi
ion
t at
t iro

ire
An

Cent al Guide W

Surgical Technique Femoral Neck System DePuy Synthes 11

Antirotation-Screw and
Locking Screw Insertion

Irrigate and apply suction for removal of debris poten-

tially generated during antirotation-screw and locking 1
screw insertion.

1. Drill for Antirotation-Screw

Instruments

03.168.011 Drill Bit B 4.3 mm, length 413 mm

2
03.168.012 Fixation Sleeve, length 60 mm

Pass the fixation sleeve over the back end of the drill bit
and check the fixation sleeve for wear per the instruc-
tions on page 32. (1) Adjust the setting to the chosen
construct size (95 mm in the example). (2)
3
Notes:
• The length of the bolt and the antirotation-screw
are pre-defined based on the selected construct e
tion W ir
A ntirota
size.
• Ensure that the central guide wire is removed
before drilling.
• Confirm that the insertion handle and plate are
aligned with the femoral shaft before drilling for
the antirotation-screw. (3)

D Use the guide of the insert to drill the hole for the
antirotation-screw. (4)

Drill until the fixation sleeve stops on the guide of the

insert. (5)

Precaution: Monitor depth during drilling using the 4

image intensifier. Drilling too deep could lead to
bone damage.
re
Wi
ion
t at

Remove the drill bit.

t iro
An

5
D

22 DePuy Synthes Femoral Neck System Surgical Technique

2. Insert Antirotation-Screw 1

Instruments

03.168.014 Screwdriver Shaft Stardrive, T25,

length 241 mm

re
511.774 Torque Limiter, 4 Nm, for AO/ASIF

Wi
Quick Coupling for Reamers

ion
D

t at
t iro
03.140.027 Handle, large, cannulated, with Quick

An
Coupling, Hex 12 mm

Note: Confirm that the insertion handle and plate

are aligned with the femoral shaft.

D Insert the antirotation-screw with the selected con-

2
struct size (95 mm in the example). (1)

Insertion as well as final tightening should be done

slowly and by hand using the screwdriver shaft, together
with the 4 Nm Torque Limiter and the appropriate
­handle. (2) If dense bone is preventing antirotation-
screw insertion, then carefully use the handle without
re
Wi

Torque Limiter for insertion.

ion
t at
t iro
An

Surgical Technique Femoral Neck System DePuy Synthes 22

Antirotation-Screw and
Locking Screw Insertion

Precautions:
• Monitor antirotation-screw insertion and confirm
screw position using the image intensifier prior to
final tightening.
• Confirm that the femoral head is temporarily
­fi xated with an antirotation wire and hold the
­position of the handle during final tightening to
prevent any inadvertent rotation.
• After final tightening, use the image intensifier 3
to check that the antirotation-screw is fully
­inserted. (3) If not, then loosen and reinsert the
­antirotation-screw. Use the 4Nm torque limiter
and the appropriate handle for final tightening.

22 DePuy Synthes Femoral Neck System Surgical Technique

3. Attach Protection Sleeve for 1
Locking Screw Insertion

Instrument

03.168.013 Protection Sleeve, for Insertion E

Instruments

Remove any antirotation wires.

E Attach the protection sleeve to the insertion handle. (1)

Notes:
• In obese patients, the use of a second incision to
insert the protection sleeve should be considered.
• Check that the protection sleeve is inserted in the
2
correct position (1-hole plate or 2-hole plate) of the
insertion handle.
• Insert the proximal locking screw first if using a
2-hole plate.

Check that the protection sleeve is fully inserted. (2)

Surgical Technique Femoral Neck System DePuy Synthes 22

Antirotation-Screw and
Locking Screw Insertion

4. Drill for Locking Screw 1

Instruments

03.168.011 Drill Bit B 4.3 mm, length 413 mm

03.168.017 Depth Gauge, measuring range up to F

100 mm (optional)

Check that the fixation sleeve is removed from the drill

bit.

Note: Confirm that the insertion handle and plate

are still aligned with the femoral shaft.

F Drill the hole for the bi-cortical locking screw through

the protection sleeve. (1) 2

Read the screw length directly off the etching on the

drill bit. (2)

Option: Use the depth gauge through the protection

sleeve to determine the depth of the drilled hole. The
screw length should be chosen at least 4 mm longer
than the determined depth of the hole. (3)

22 DePuy Synthes Femoral Neck System Surgical Technique

5. Insert Locking Screw 1

Instruments

03.168.014 Screwdriver Shaft Stardrive, T25,

length 241 mm
or
03.168.016 Screwdriver Shaft hexagonal, 3.5 mm,
length 241 mm F

511.774 Torque Limiter, 4 Nm, for AO/ASIF

Quick Coupling for Reamers

03.140.027 Handle, large, cannulated, with Quick

Coupling, Hex 12 mm

Note: Confirm that the insertion handle and plate

2
are still aligned with the femoral shaft.

F Insert the locking screw with the determined length,

as read from the drill bit or depth gauge. (1)

The locking screw may be inserted using power equip-

ment. Final tightening must be done slowly and by hand
using the screwdriver shaft, together with the 4 Nm
Torque Limiter and the appropriate handle. (2)

Note: Monitor locking screw insertion and confirm

screw position as well as length using the image
intensifier prior to final tightening.

Option: If using a 2-hole plate, repeat steps 3 to 5 to

insert the distal screw. (3)
3

Surgical Technique Femoral Neck System DePuy Synthes 22

Antirotation-Screw and
Locking Screw Insertion

6. Remove Protection Sleeve 1

Remove the protection sleeve by pressing together the

head of the sleeve while pulling. (1)

22 DePuy Synthes Femoral Neck System Surgical Technique

Option: Intra-Operative Compression

Inter-fragmentary compression may be applied intra-­

operatively. The locking screw as well as the antirotation- 1
screw need to be inserted prior to applying compression.

1. A
 ttach Multifunction Rod for
Compression

Instrument

03.168.010 Multifunction Rod for Insertion

Instruments (optional)

Insert the multifunction rod through the guide of the

antirotation-screw. (1)

Hand-tighten the rod by turning it clockwise until the

rod is fully inserted. (2) 2

Surgical Technique Femoral Neck System DePuy Synthes 22

Option: Intra-Operative Compression

2. Apply Compression 1

Note:
• If applicable, consider to loosen traction before
­applying compression.
• Monitor the implant position during compression
using the image intensifier.

Apply inter-fragmentary compression by turning the

screw of the insert counter-clockwise. (1)

Precaution: Applying compression by hand is suffi-

cient. Using additional tools for compression might
cause excessive forces.

Before Compression After Compression

22 DePuy Synthes Femoral Neck System Surgical Technique

3. Remove Multifunction Rod 1

Remove the multifunction rod by turning it counter-

clockwise. (1)

Note: If loosening by hand is not possible, then

use another instrument (e.g. a screwdriver shaft)
through the hole in the multifunction rod to un-
tighten it.

Use image intensification to confirm that the anti­

rotation-screw remains locked in the implant.

Surgical Technique Femoral Neck System DePuy Synthes 22

Instrument Disassembly and Final Check

1. Remove Insertion Instruments 1 2

Unscrew (counter-clockwise) the insert from the inser-

tion handle by completely loosening the screw of the
insert. (1)

Remove the insert from the insertion handle. (2)

Remove the insertion handle by sliding it off the plate in

a distal direction. (3)

33 DePuy Synthes Femoral Neck System Surgical Technique

2. Final Check 1

Before closing the wound, confirm the implant size and

positioning under image intensifier control. (1)

Surgical Technique Femoral Neck System DePuy Synthes 33

Option: Implant Removal

Irrigate and apply suction for removal of debris poten-

1
tially generated during implant removal.

1. Remove Locking Screw

Instruments

03.168.014 Screwdriver Shaft Stardrive, T25,

length 241 mm
or
03.168.016 Screwdriver Shaft hexagonal, 3.5 mm,
length 241 mm

03.010.516 Handle, large, with Quick Coupling

Remove the locking screw by hand using the screwdriver

shaft together with the appropriate handle and without 2 3
torque limiter. (1)

If the screw cannot be removed with the screwdriver,

consult the separate publication “Screw Extraction Set”
(DSEM/TRM/0614/0104).

Note: If the implant is fully telescoped, resulting in

the bolt being more lateral than the plate (2), pull on
the plate (e.g. with surgical pliers) to extend it from
the bolt (to about 5 mm) before conducting the steps
on the following pages. (3)

33 DePuy Synthes Femoral Neck System Surgical Technique

2. Remove Antirotation-Screw 1

Instruments

03.168.014 Screwdriver Shaft Stardrive, T25,

length 241 mm

03.010.516 Handle, large, with Quick Coupling

03.168.010 Multifunction Rod for Insertion

Instruments (optional)

Remove the antirotation-screw by hand using the screw-

driver shaft together with the appropriate handle and
without torque limiter. (1)

Options:
2
• If it is difficult to find the recess of the antirotation-
screw, then use the Insert (03.168.009) as a guide
within the plate. (2)
• If the antirotation-screw gets detached from the
screwdriver, then use the multifunction rod and turn it
clockwise to catch the antirotation-screw. Pull on the
multifunction rod and turn anti-clockwise to fully re-
move the antirotation-screw. (3)

If the antirotation-screw cannot be removed with the

screwdriver or the multifunction rod, consult the sepa-
rate publication “Screw Extraction Set”
(DSEM/TRM/0614/0104).

Surgical Technique Femoral Neck System DePuy Synthes 33

Option: Implant Removal

3. Remove Plate and Bolt 1

Instruments

03.168.010 Multifunction Rod for Insertion

Instruments

03.168.015 Cylinder, for Insertion Instruments

Slide the cylinder over the multifunction rod. (1)

Attach the multifunction rod by turning it clockwise. Use

the direction of the previously removed antirotation-
screw. (2)

Tap outward with the cylinder to remove the plate and

bolt simultaneously. (3) 2

Note: Avoid excessive forces during removal.

33 DePuy Synthes Femoral Neck System Surgical Technique

Checking Fixation Sleeve Wear

1. Perform Fixation Sleeve Wear Test

Instruments

03.168.011 Drill Bit B 4.3 mm, length 413 mm

03.168.012 Fixation Sleeve, length 60 mm

If excessive wear occurs, the fixation sleeve can slip,

resulting in incorrect drilling depth.

Before use:
• Slide fixation sleeve onto the drill bit
• Press on the fixation sleeve with the thumb without
pressing the button. If the fixation sleeve moves under
pressure, replace it
• Do the same test in the opposite direction. If the fixa-
tion sleeve moves, replace it

Precautions:
• Drill only under periodic image intensifier control.
• While drilling, do not force.
• Replace fixation sleeves that do not pass the de-
scribed wear test.

Surgical Technique Femoral Neck System DePuy Synthes 33

Implants in Kit Packaging

Implant Kit

04.168.075S Implant Kit, for Femoral Neck System,

Construct Length 75 mm, Titanium
Alloy (TAN), sterile

04.168.080S Implant Kit, for Femoral Neck System,

Construct Length 80 mm, Titanium
Alloy (TAN), sterile

04.168.085S Implant Kit, for Femoral Neck System,

Construct Length 85 mm, Titanium
Alloy (TAN), sterile

04.168.090S Implant Kit, for Femoral Neck System,

Construct Length 90 mm, Titanium
Alloy (TAN), sterile

04.168.095S Implant Kit, for Femoral Neck System,

Construct Length 95 mm, Titanium
Alloy (TAN), sterile

04.168.100S Implant Kit, for Femoral Neck System,

Construct Length 100 mm, Titanium
Alloy (TAN), sterile

04.168.105S Implant Kit, for Femoral Neck System,

Construct Length 105 mm, Titanium
Alloy (TAN), sterile

04.168.110S Implant Kit, for Femoral Neck System,

Construct Length 110 mm, Titanium
Alloy (TAN), sterile

04.168.115S Implant Kit, for Femoral Neck System,

Construct Length 115 mm, Titanium
Alloy (TAN), sterile

04.168.120S Implant Kit, for Femoral Neck System,

Construct Length 120 mm, Titanium
Alloy (TAN), sterile

04.168.125S Implant Kit, for Femoral Neck System,

Construct Length 125 mm, Titanium
Alloy (TAN), sterile

04.168.130S Implant Kit, for Femoral Neck System,

Construct Length 130 mm, Titanium
Alloy (TAN), sterile

33 DePuy Synthes Femoral Neck System Surgical Technique

Implants in Single Packaging

Plate

04.168.000S Plate, 1 hole, for Femoral Neck System,

Titanium Alloy (TAN), sterile

04.268.000S Plate, 2 holes, for Femoral Neck System,

Titanium Alloy (TAN), sterile

Surgical Technique Femoral Neck System DePuy Synthes 33

Implants in Single Packaging

Bolt

04.168.275S Bolt, for Femoral Neck System, for

Construct Length 75 mm, Titanium
Alloy (TAN), sterile

04.168.280S Bolt, for Femoral Neck System, for

Construct Length 80 mm, Titanium
Alloy (TAN), sterile

04.168.285S Bolt, for Femoral Neck System, for

Construct Length 85 mm, Titanium
Alloy (TAN), sterile

04.168.290S Bolt, for Femoral Neck System, for

Construct Length 90 mm, Titanium
Alloy (TAN), sterile

04.168.295S Bolt, for Femoral Neck System, for

Construct Length 95 mm, Titanium
Alloy (TAN), sterile

04.168.300S Bolt, for Femoral Neck System, for

Construct Length 100 mm, Titanium
Alloy (TAN), sterile

04.168.305S Bolt, for Femoral Neck System, for

Construct Length 105 mm, Titanium
Alloy (TAN), sterile

04.168.310S Bolt, for Femoral Neck System, for

Construct Length 110 mm, Titanium
Alloy (TAN), sterile

04.168.315S Bolt, for Femoral Neck System, for

Construct Length 115 mm, Titanium
Alloy (TAN), sterile

04.168.320S Bolt, for Femoral Neck System, for

Construct Length 120 mm, Titanium
Alloy (TAN), sterile

04.168.325S Bolt, for Femoral Neck System, for

Construct Length 125 mm, Titanium
Alloy (TAN), sterile

04.168.330S Bolt, for Femoral Neck System, for

Construct Length 130 mm, Titanium
Alloy (TAN), sterile

33 DePuy Synthes Femoral Neck System Surgical Technique

Antirotation-Screw

04.168.475S Antirotation Screw, for Femoral Neck

System, for Construct Length 75 mm,
Titanium Alloy (TAN), sterile

04.168.480S Antirotation Screw, for Femoral Neck

System, for Construct Length 80 mm,
Titanium Alloy (TAN), sterile

04.168.485S Antirotation Screw, for Femoral Neck

System, for Construct Length 85 mm,
Titanium Alloy (TAN), sterile

04.168.490S Antirotation Screw, for Femoral Neck

System, for Construct Length 90 mm,
Titanium Alloy (TAN), sterile

04.168.495S Antirotation Screw, for Femoral Neck

System, for Construct Length 95 mm,
Titanium Alloy (TAN), sterile

04.168.500S Antirotation Screw, for Femoral Neck

System, for Construct Length 100 mm,
Titanium Alloy (TAN), sterile

04.168.505S Antirotation Screw, for Femoral Neck

System, for Construct Length 105 mm,
Titanium Alloy (TAN), sterile

04.168.510S Antirotation Screw, for Femoral Neck

System, for Construct Length 110 mm,
Titanium Alloy (TAN), sterile

04.168.515S Antirotation Screw, for Femoral Neck

System, for Construct Length 115 mm,
Titanium Alloy (TAN), sterile

04.168.520S Antirotation Screw, for Femoral Neck

System, for Construct Length 120 mm,
Titanium Alloy (TAN), sterile

04.168.525S Antirotation Screw, for Femoral Neck

System, for Construct Length 125 mm,
Titanium Alloy (TAN), sterile

04.168.530S Antirotation Screw, for Femoral Neck

System, for Construct Length 130 mm,
Titanium Alloy (TAN), sterile

Surgical Technique Femoral Neck System DePuy Synthes 33

Implants in Single Packaging

5.0 mm Locking Screws*

412.201 – Locking Screw Stardrive B 5.0 mm,

412.227 self-tapping, Titanium Alloy (TAN)

413.314 – Locking Screw B 5.0 mm,

413.390 self-tapping, Titanium Alloy (TAN)

* Available non-sterile and sterile packed. Add “S” to the article number to
order sterile products.

44 DePuy Synthes Femoral Neck System Surgical Technique

Instruments

03.168.001 Angled Guide 130°, for Guide Wires

B 3.2 mm

03.168.002 Correction Guide, for Guide Wires

B 3.2 mm (optional)

357.399* Guide Wire B 3.2 mm, length 400 mm

356.830* Guide Wire B 3.2 mm, for PFNA Blade

(alternative to 357.399)

03.168.003 Direct Measuring Device, for Guide

Wires B 3.2 mm

03.168.004 Reamer, complete

Consisting of:
03.168.005 Drill Bit B 10.2 mm, cannulated,
length 251 mm
03.168.006 Reamer B 12.5 mm
03.168.007 Nut, for Reamer

03.168.008 Insertion Handle

* Available non-sterile and sterile packed. Add “S” to the article number to
order sterile products.

Surgical Technique Femoral Neck System DePuy Synthes 44

Instruments

03.168.009 Insert, for Insertion Handle

03.168.010 Multifunction Rod for Insertion

Instruments

03.168.011 Drill Bit B 4.3 mm, length 413 mm

03.168.012 Fixation Sleeve, length 60 mm

03.168.013 Protection Sleeve, for Insertion

Instruments

03.168.014 Screwdriver Shaft Stardrive, T25,

length 241 mm

03.168.015 Cylinder, for Insertion Instruments

03.168.016 Screwdriver Shaft hexagonal, 3.5 mm,

length 241 mm (alternative to
03.168.014 for Locking Screw insertion)

03.168.017 Depth Gauge, measuring range up to

100 mm (optional)

44 DePuy Synthes Femoral Neck System Surgical Technique

03.140.027 Handle, large, cannulated, with Quick
Coupling, Hex 12 mm

511.774 Torque Limiter, 4 Nm, for AO/ASIF

Quick Coupling for Reamers

03.010.516 Handle, large, with Quick Coupling

Surgical Technique Femoral Neck System DePuy Synthes 44

 DSEM/TRM/0614/0098(2) 06/17
© DePuy Synthes Trauma, a division of Synthes GmbH. 2017. All rights reserved.

Synthes GmbH
Eimattstrasse 3 Not all products are currently available in all markets.
4436 Oberdorf
Switzerland This publication is not intended for distribution in the USA.
Tel: +41 61 965 61 11
Fax: +41 61 965 66 00 All surgical techniques are available as PDF files at
www.depuysynthes.com www.depuysynthes.com/ifu 0123