Trauma

T2
Proximal Humeral Nailing
System Operative Technique
Proximal Humeral Nailing System

Contributing Surgeons:

Rupert Beikert, M.D.

Senior Trauma Surgeon, Murnau Trauma Center
Murnau,
Germany

Rosemary Buckle, M.D.

Orthopaedic Associates, LLP, Christus St. Joseph Hospital, Clinical Instructor,
University of Texas, Medical School
Houston, Texas,
USA

Prof. Dr. med. Volker Bhren

Chief of Surgical Services, Medical Director of Murnau Trauma Center
Murnau,
Germany

Joseph D. DiCicco III., D.O.

Director Orthopaedic Trauma Service, Good Samaritan Hospital, Dayton, Ohio
Associate Clinical Professor of Orthopaedic Surgery,
Ohio University and Writght State University,
USA

Carl Ekholm, M.D., Ph.D.

Associate Professor, Senior Trauma Surgeon Orthopaedic Trauma,
Department of Orthopaedic Surgery
Sahlgrenska University Hospitalv and Gothenburg University
Gothenburg,
Sweden

Anders Jnsson, M.D., Ph.D.

Senior Trauma Surgeon Orthopaedic Trauma,
Department of Orthopeadic Surgery
Sahlgrenska University Hospital and Gothenburg University
Gothenburg,
Sweden

Robert J. Nowinski, D.O.

Assistant Clinical Professor of Orthopaedic Surgery,
Ohio University College of Osteopathic Medicine
Private Practice, Orthopaedic Specialists & Sports Medicine, Inc.
Newark, Ohio,
USA
This publication sets forth detailed
Anthony T. Sorkin, M.D. recommended procedures for
Rockford Orthopaedic Associates, LLP, Clinical Instructor, using Stryker Trauma devices and
Department of Surgery University of Illinois, instruments.
College of Medicine Director,
Orthopaedic Traumatology Reckford Memorial Hospital It offers guidance that you should
Rockford, Illinois, heed, but, as with any such technical
USA guide, each surgeon must consider
the particular needs of each patient
and make appropriate adjustments
when and as required.

A workshop training is required prior

to first surgery.

2
Contents

1. Introduction 4

1.1. Implant Features 4

1.2. Instrument Features 6

2. Indications 7

3. Pre-operative Planning 7

4. Locking Option Examples 7

5. Operative Technique 8

5.1. Patient Positioning 8

5.2. Incision 8
5.3. Entry Point 8

5.4. Nail Selection 9

5.5. Nail Insertion 10

5.6. Proximal Guided Locking 12

5.7. Proximal A/P Locking 15

5.8. Distal Guided Locking 16

5.9. End Cap Insertion 17

5.10. Nail Removal 17

Ordering Information-Implants 18

Ordering Information-Instruments 19

3
Introduction

1. Introduction 1.1. Implant Features

Proximal humeral fractures can To complement the T2 Nailing fragmented tuberosities. However,
be difficult to treat, particularly System, Stryker Trauma has created they can also stabilise the nail,
multifragmented fractures in a "new generation" humeral implant: allowing compression of the sur-
osteopenic bone. A large number the T2 Proximal Humeral Nail for rounding bone against the nail.
of treatment modalities have been the treatment of complex proximal The Distal Locking Hole configu-
developed over the years. humeral fractures. ration allows for either Static
Treatments range from conservative or Dynamic Locking Modes.
measures such as swathe, to per- Although based on the well-known In the Dynamic Locking mode
cutanous procedures using pins, T2 platform, the T2 Proximal the pull of muscles spanning the
wires and screws onwards to open Humeral Nail design incorporates a fracture may be used for secondary
procedures with plate fixation and number of unique features: dynamization.
even joint replacement. The curvature of the nail allows
Problems lie in the difficulty of Small diameter intramedullary insertion at the standard insertion
obtaining fixation of one or several implant that requires only a 10mm point, i.e. lateral entry just inside
fragments and achieving rotator cuff entrance hole and minimal canal the Greater Tuberosity, or central
stability to allow early motion. preparation. insertion, i.e. through the articular
Reduction and fixation must be Left and right versions, designed surface at the top of the humeral
performed without disturbing the to reduce possible interference with head. Central insertion improves
blood supply to the fracture fragments. the axillary nerve. fixation through interference be-
Finally, the implants used should End Caps, of three different tween the subchondral bone at the
be low profile so as not interfere heights in 2mm increments, allow entry point and the proximal end of
with surrounding soft tissue or the fine adjustment to the length of the the nail.
acromion. Additionally, the risk nail and optimize the purchase of The 6 lateral bend allows insertion
of implant migration should be the nail in the entrance hole. of the nail along an almost straight
minimized. Four Proximal Locking Holes path. The risk of losing reduction
strategically placed to enable of fragments during insertion is
locking of separate fragments of thereby minimized.
the Lesser Tuberosity, the Greater The nail may be used for percu-
Tuberosity and the Humeral Head. tanous reduction and insertion
The Proximal Locking Holes in or open insertion through a
the nail are threaded. Thus, the deltopectoral approach when
holding strength of the Locking indicated.
Screws will not depend on purchase The solid nail eliminates the need
in the often poor cancellous bone. for reaming over a Guide Wire.
The Locking Screws can also pro-
vide firm anchoring for suture All implants of the T2 Proximal
augmentation of the Tuberosity Humeral System are made from Type
fragment. II anodized titanium alloy (Ti6Al4V)
The Proximal Locking Holes in the to maximize mechanical strength
nail have a nylon bushing. This and biocompatibility.
will further improve the holding
strength of the screws and helps See the detailed chart on the next
avoid screw back out. It also stops page for design specification and size
screw toggle, thereby minimizing offering.
mechanical destruction of osteo-
penic bone.
Washers may be used in con-
junction with the Screws for fixing

4
Technical Details

Left Right
0
Nails
Distal Diameter 8mm* 10 9.5
Sizes 150mm
17

23
Note:
Screw length is measured 29.5
9
from top of head to tip.

Fully Threaded
Locking Screw** 62
Bend,6
Length 2560mm
Diameter 5mm

80

95

101

Fully Threaded
Locking Screw***
Length 2060mm
Diameter 4mm

Washers
Round:
Diameter 17mm

Square:
Size 1018mm

Proximal Humerus
End Cap * Nail driving end has a diameter of 10mm.
** For Proximal Locking Only
*** For Distal Locking Only
standard**** +2mm +4mm **** standard End Cap is flush with the nail

5
Features

1.2. Instrument Features

The majority of the instruments come from the existing T2 platform.

Only a new Targeting Device has been designed, unique for the T2
Proximal Humeral Nail*.

The instrumentation is characterized Nail Holding Screw

as follows:
Nut, Proximal Humerus
A unique carbonfiber, radiolucent
Targeting Device (Fig. 1) that allows
exact placement of all Proximal and
Distal Locking Screws.
A K-Wire inserted through the
Targeting Device and aligned
with the forearm indicates the
correct rotational alignment
of the Targeting Device and
Nail. Alignment is based on the
assumption that anatomical
retroversion of the humeral head Nail Adapter,
is 30. Proximal Humerus
A second K-Wire inserted through
the Targeting Device indicates the
exact top end of the nail to aid
achieving the correct insertion
depth.
A Friction Locking Mechanism
firmly holds the Drill Sleeves
in their required position. The
Drill Sleeves, when locked into
the targeting device, will also
help to stabilize the nail and may
temporarily stabilize fragments
during fixation.
Calibrated Drill bits give correct
measurements of screw length. Targeting Arm,
Proximal Humerus
Proximal screw holes are manually
drilled. This improves the surgeons
feel of the bone.
Two sets of Tissue Protection Sleeves
and Drill Sleeves provide the op-
portunity to temporarily fix the
nail with one set while the other
set can be used for placing the first
screw.
Fig. 1

6
Indications

2. Indications 2-part 3-part 4-part

Anatomical
Neck
The T2 Proximal Humeral Nail is
indicated for:

Two-part fractures of the humerus Surgical

Three-part fractures of the humerus Neck

Four-part fractures of the humerus

Note:
The most important step before Greater
Tuberosity
surgery remains a proper analysis of
the fracture type.

3. Pre-operative Planning Lesser

Tuberosity

Thorough evaluation of pre-operative

radiographs of the affected Upper
Arm and Shoulder is critical. Careful Fracture

Anterior
radiographic examination of the Dislocation
Humeral head region may prevent
intra-operative complications. Posterior

NEER Classification

4. Locking Option Examples:

7
Operative Technique

5. Operative Technique
5.1. Patient Positioning and Fracture Reduction

The patient is placed semi-reclined in

beach chair position or supine on a
radiolucent table. Patient positioning
should be checked to ensure that
imaging and access to the entry site are
possible without excessive manipula-
tion of the affected extremity (Fig. 2).

Note:
Closed reduction by Joystick-
technique with K-wires to
manipulate fragments can be used.

If closed reduction was not successful,

Fig. 2
open reduction should be performed.

5.2. Incision

A small incision is made in line

with the fibers of the deltoid muscle
anterolateral to the acromion. The
deltoid is split to expose the sub-
deltoid bursa (Fig. 3). The suprasp-
inatus tendon is then incised in line
with its fibers.

5.3. Entry Point Fig. 3

To indicate the exact entry point

before incising the supraspinatus
tendon, a K-Wire (1806-0050S) can
be placed through the tendon into the B
bone at the expected entry point
(Fig. 4): Confirmation should be made A
with the image intensifier, in both
lateral and A/P views.

The T2 Proximal Humeral Nail is

designed to be inserted either through
a lateral (A) or a central (B) entry
Fig. 4
point (Fig. 4).

The lateral entry point (A) is located The central entry point (B) is located
just inside the Greater Tuberosity at the very top of the humeral head, in
(as seen on the A/P view) and aligned the articular surface, in line with the
with the humeral axis (as seen on the humeral axis (in both A/P and lateral
lateral view). Verify with the image views).
intensifier.

8
Operative Technique

The entry point is made with the

cannulated 10mm Awl, Straight (1806-
0045) or by using the Small K-Wire
(1806-0050) with the Guide Wire
Handle (1806-0095) (Fig. 5). Image
intensification is required to identify
the correct entry point. The proximal
metaphysis should be reamed with
the Rigid Reamer, 10mm (1806-2010)
through the Rigid Reamer Sleeve,
10mm (1806-0410).

Alternatively, the optional Crown Drill

(1806-2020) may be used over the
K-Wire for entry portal preparation.
If the Rigid Reamer or Crown Drill
cannot be used because of the fracture
pattern or poor bone quality, use the
10mm Awl, Straight to prepare the
proximal metaphysis.

Further reaming is not necessary with

Fig. 5
the Proximal Humeral Nail. The nail
may be inserted directly.

Note:
During opening the entry portal with
the Awl, dense cortex may block the
tip of the Awl. An Awl Plug (1806-
0032) can be inserted through the Awl
to avoid penetration of bone debris
into the cannulation of the Awl shaft.

5.4. Nail Selection

The Proximal Humeral Nail is

available in Right and Left, one
diameter and one length (Fig. 6).

Left Right

Fig. 6

9
Operative Technique

5.5. Nail Insertion

The selected nail is attached to the

Nail Adapter (1806-2025) until its 3
connection teeth engage into the cor-
responding slots of the Nail (Fig. 7).

The Nail Holding Screw (1806-0163) is

placed through the Nail Adapter, and
tightened securely with the Insertion
Wrench (1806-0135) or Wrench 8/ 2mm
10mm (1806-0130) to avoid loosening 5mm

during Nail insertion. Engravings on

the Nail Adapter will indicate lateral
Fig. 7
and medial direction (Fig. 8).

Fig. 8

Fig. 9

Note:
Two circumferential grooves are
located on the insertion post at 2mm
and 5mm from the driving end of the
nail (Fig. 7). Depth of insertion may be
visualized with the aid of fluoroscopy.

Note:
The Strike Plate (1806-0150) (Fig.
9) or the Short Universal Rod
(1806-0113) may be used to improve
handling during insertion. These
are screwed into the Nail Holding
Screw and have to be removed if the
Targeting Arm (1806-2035) is to be
mounted after introduction of the
nail.

10
Operative Technique

Alternatively, the Targeting Arm is

assembled onto the Nail Adapter with
the Nut (1806-2030) (Fig. 10.a). Hand
tighten the Nut so that it does not
loosen during nail insertion.

Note:
Before inserting the nail, verify that
the assembly is locked in the appro-
priate position: the smaller peg of the
Nail Adapter engaged into the smaller
slot of the Targeting Arm indicated
by the LATERAL Locking sign (Fig. small large
10a) and the larger peg into the larger
slot on the opposite side (Fig. 10b).
Fig. 10a Fig. 10b

Note: Note:
Prior to nail insertion please check The nail is ready for insertion. Do not hit the Targeting Device
correct alignment by inserting a drill Advance it through the entry point and/or the Nail Holding Screw.
bit through the assembled Tissue (Fig. 12). Gentle rotation of the nail
Protection- and Drill Sleeve placed may be necessary for nail insertion. Note:
in the required holes of the targeting The nail should be advanced with The nail should be inserted at least up
device (Fig. 11). manual pressure. Aggressiveness to the first circumferential groove on
can result in additional fractures or the Nail Adapter but not deeper than
fragment displacements. If the nail up to the second groove.
does not advance easily, use the image
intensifier to identify the problem.

Fig. 11 Fig. 12

11
Operative Technique

5.6. Proximal Guided Locking

Prior to guided locking via the Target

Device, the Nail Holding Screw and
the Nut must be firmly tightened
to ensure that the nail is in correct
alignment with the Targeting Device
(Fig. 13).
Fig. 13

Note:
Remove the Strike Plate if used.

Note:
Two sets of Tissue Protection
Sleeves, Drill Sleeves and Trocars
can be inserted at the same time.
This provides the opportunity to
temporarily stabilise the nail and the
fracture during locking.

Note:
A K-Wire placed through the Target- Fig. 14
ing Device and aligned with the
forearm indicates anatomical 30
retroversion of the humeral head
(Fig. 14).

Note:
Except for the A/P Proximal Locking
Screw, all of the Proximal and Distal
Locking procedure can be performed
without changing position of the Tar-
geting Arm.

Note:
For the use of an A/P Locking Screw
see Chapter 5.7.

The Short Tissue Protection Sleeve

(1806-0180) together with the Short
Drill Sleeve (1806-0210) and the Short
Trocar (1806-0310) are inserted into
the Targeting Arm by pressing the
Safety Clip (Fig. 15a & b).
Fig. 15a
The friction locking mechanism is
designed to keep the sleeve in place. It
will also stop the sleeve from sliding
during screw measurement. To release Locked
the Tissue Protection Sleeve, the Safety
Released
Clip must be pressed again.

Fig. 15b
12
Operative Technique

The Trocar is removed, while the

Tissue Protection Sleeve and the
Drill Sleeve remain in position. The
T-Handle (702427) is assembled with
the 3.5230mm Drill (1806-3540S).
Drilling is preferably done manually
to improve feel of resistance in soft 3,5mm

bone. The Drill is forwarded through

the Drill Sleeve and pushed onto the
cortex (Fig. 16).

Advance the Drill until it is in contact

with the subchondral bone. The
appropriate screw length may be read
directly off of the Drill at the end of
the Drill Sleeve (Fig. 16).

50mm

Fig. 16

Note:
Do not drill through the far cortex as
this will penetrate the joint.

Note:
The position of the Drill tip placed
in the subchondral bone is equal to
where the end of the screw will be. 5mm

Note:
The Locking Screw length determi-
nation is very important and must be
carried out carefully.

In cases with dense bone the cortex

of the proximal locking holes may be
opened with the 5.0180mm Drill
(1806-5010).

Note:
Drill the lateral cortex only. In cases
where the nail is inserted close to the
lateral cortex, manual drilling will
help to avoid nail contact. Fig. 17

13
Operative Technique

When the Drill Sleeve is removed,

the correct 5.0mm Fully Threaded
Locking Screw is inserted through
the Tissue Protection Sleeve using the
Screwdriver Shaft Short (1806-0224)
with the Teardrop Handle (702429)
(Fig. 18).

Note:
In order to optimize screw insertion
in the threaded screw hole, push the
Locking Screw without rotating
through the first cortex until it is
in contact with the nail. Then start
turning the Locking Screw with gentle
axial pressure to engage the internal
thread of the nail. In cases with dense
bone where the screw cannot be pushed
forward the lateral cortex may be
opened with the 5.0180mm to ease
screw insertion as described above.
Fig. 18
Note:
To avoid loss of reduction or position
of the nail when the Drill is removed,
leave the first Drill in the in the bone.
Then, using the second set of Sleeves,
drill the second hole and insert this
screw while the nail is stabilized by
the first Drill. Fig. 19

The Locking Screw is near its proper

seating position when the groove
around the shaft of the Screwdriver
is approaching the end of the Tissue
Protection Sleeve (Fig. 19).

Note:
Fluoroscopic visualisation during
Locking Screw insertion is absolutely
necessary to place the tip of the
Locking Screw in the subchondral
bone to stabilize head fragment and
avoid penetration of the Locking
Screw into the articular surface.

Note:
In four part fractures the role of the
first Proximal Screw is to obtain fixa-
tion of the Head Fragment and not of
the Greater Tuberosity.

Repeat the locking procedure for all

lateral Proximal Locking Screws
(Fig. 20).
Fig. 20
14
Operative Technique

A Washer, either Rectangular or

Round, is available for patients with
osteoporotic bones. It can be used in
conjunction with the Screw for fixing
fragmented tuberosities. However,
they can also be used to stabilise the
nail, allowing compression of the
surrounding bone against the nail.

Note:
Do not use a Washer with the most
Proximal Locking Screw as it may
cause Acromial impingement.

5.7. Proximal A/P Locking

Note:
The A/P Screw is designed to fix the
Lesser Tuberosity. If the A/P Screw
is inserted it is recommended to per-
form the A/P Screw locking after all
required screws are inserted.

To place the A/P Locking Screw, the

Targeting Arm must be rotated. The
Nut must be released with 4 complete
turns. Pull-up the Targeting Arm and Fig. 21
turn it anteriorly around the Nail
Adapter (Fig. 21). Push down the Tar-
geting Arm and lock the system in the
appropriate position indicated on the
Targeting Arm (Fig. 22a).

For the left nail, the larger peg of the (For the right nail, the smaller peg Hand tighten the Nut to ensure it does
Nail Adapter engages into the larger must be engaged into the smaller not loosen during locking procedure.
slot indicated by the AP locking left slot, indicated by the AP Locking
sign (Fig. 22a) and the smaller peg into right sign and the larger peg into the Routine locking procedure is
the opposite smaller slot (Fig. 22b). opposite larger slot.) performed as described in Chapter 5.6.

Fig. 22a Fig. 22b

15
Operative Technique

5.8 Distal Guided Locking

The Targeting Device is designed to

provide two Distal Locking Options;
Static Mode or Dynamic Mode.

For Static Locking Mode, two Distal

Locking Screws should be used (round
and oblong hole).

The Short Tissue Protection Sleeve

together with the Short Drill Sleeve
and the Short Trocar are inserted into
the Targeting Arm in the static hole.

A small skin incision is made and the

assembly is pushed through until it is
in contact with the lateral cortex.

The Trocar is removed, while the

Tissue Protection Sleeve and the Drill
Sleeve remain in position.

After drilling both cortices with the

calibrated 3.5230mm Drill (1806-
3540S), the screw length may be read
Fig. 23
directly off of the calibrated Drill at
the end of the Drill Sleeve.

Alternatively, after removal of the Drill

Sleeve, the Screw Gauge, Short (1806-
0330) can be used for screw length
measurement.

The 4mm Locking Screw is inserted

with the assembled Short Screwdriver
Shaft and the Teardrop Handle.

For the second distal Locking Screw,

routine Screw insertion is employed
using the dynamic hole on the
Targeting Arm.

Note:
The dynamic hole on the Targeting
Arm will allow placement of the
Locking Screw in a Dynamic Locking
Mode (at the bottom of the oblong
hole) (Fig. 23).

Depending on the fracture type,

secondary dynamization can be
achieved by extracting the static distal
Locking Screw (round hole) (Fig. 24).
Fig. 24

16
Operative Technique

5.9. End Cap Insertion

After removal of the Targeting Device

an End Cap may be inserted. End Caps
are available in three sizes.
standard +2mm +4mm

The End Cap is inserted with the

Screwdriver Shaft, Short (1806-0224)
assembled on the Teardrop Handle
(Fig. 25). Fully seat the End Cap to
minimize the risk of loosening.

End Cap may be used to:

Lock and stabilize the Proximal
Locking Screw.
Adjust the height of the nail for
optimal purchase of the nail at the
entry point.

Note: Fig. 25
To avoid impingement carefully select
the length of the End Cap.

Close the wound using a standard

technique.

5.10. Nail Removal

Nail removal is an elective procedure.

The End Cap, if used, and the most
proximal Locking Screw are removed
with the Conical Screwdriver Shaft
and the Teardrop Handle. Fig. 26

Note:
Attaching the Universal Rod, Short
to the nail before removal of all other
Locking Screws, will prevent nail
migration.

The Short Universal Rod is inserted

into the driving end of the nail. All
Locking Screws are removed with
the Short Screwdriver Shaft and the
Teardrop Handle (Fig. 26).

The nail may then be removed with

the Slotted Hammer (Fig. 27).

Fig. 27
17
Ordering Information - Implants

T2 Proximal Humerus Nail 4mm Fully Threaded Locking Screws

REF Description REF Diameter Length

mm mm
1832-1025S T2 Proximal Humeral Nail, left
1832-1015S T2 Proximal Humeral Nail, right 1896-4020S 4.0 20
1896-4022S 4.0 22
1896-4024S 4.0 24
1896-4025S 4.0 25
1896-4026S 4.0 26
1896-4028S 4.0 28
1896-4030S 4.0 30
1896-4032S 4.0 32
1896-4034S 4.0 34
1896-4035S 4.0 35
1896-4036S 4.0 36
1896-4038S 4.0 38
1896-4040S 4.0 40
1896-4045S 4.0 45
1896-4050S 4.0 50
left right 1896-4055S 4.0 55
1896-4060S 4.0 60

End Caps 5mm Fully Threaded Locking Screws

REF Diameter Length REF Diameter Length

mm mm mm mm

1832-0003S 6 standard 1896-5025S 5.0 25.0

1832-0002S 10 +2 1896-5027S 5.0 27.5
standard
1832-0004S 10 +4 1896-5030S 5.0 30.0
1896-5032S 5.0 32.5
1896-5035S 5.0 35.0
+2mm 1896-5037S 5.0 37.5
1896-5040S 5.0 40.0
1896-5042S 5.0 42.5
1896-5045S 5.0 45.0
1896-5047S 5.0 47.5
+4mm
1896-5050S 5.0 50.0
1896-5052S 5.0 52.5
1896-5055S 5.0 55.0
1896-5057S 5.0 57.5
1896-5060S 5.0 60.0

Washer

REF Description Diameter

Length
mm
1830-0008S Washer, round 17.0
1830-0009S Washer, square 1018
round

square

Implants in sterile packaging

18
Ordering Information - Instruments

REF Description REF Description

Standard Instruments Optional Instruments

702427 T-Handle, AO Coupling 1806-0032 Awl Plug

702429 Teardrop Handle, AO Coupling 1806-2020 Crown Drill

1806-0045 Awl, Straight 1806-3540S Drill 3.5230mm, AO, Sterile (2)

1806-0050 K-Wire, 3285mm (2) 1806-5010S Drill 5180mm, AO, Sterile (2)

1806-0095 Guide Wire Handle

1806-0096 Guide Wire Handle Chuck

1806-0113 Universal Rod, Short

1806-0130 Wrench, 8mm/10mm

1806-0135 Insertion Wrench, 10mm

1806-0150 Strike Plate

1806-0163 Nail Holding Screw, Humerus

1806-0180 Tissue Protection Sleeve, Short (2)

1806-0210 Drill Sleeve, Short (2)

1806-0224 Screwdriver Shaft AO, Short

1806-0237 Screwdriver Short

1806-0310 Trocar, Short (2)

1806-0330 Screw Gauge, Short

1806-0410 Rigid Reamer Sleeve, 10mm

1806-0411 Rigid Reamer Trocar, 10mm

1806-2000 Targeting Device,

Proximal Humerus, complete

1806-2010 Rigid Reamer, 10mm

1806-2025 Nail Adapter, Proximal Humerus

1806-2030 Nut, Proximal Humerus

1806-2035 Targeting Arm, Proximal Humerus

1806-3540 Drill 3.5230mm, AO, (2)

1806-5010 Drill 5180mm, AO, (2)

1806-9300 T2 PHN Instrument Tray 2003 Stryker Corporation. All rights

1806-9310 Add-On T2 PHN Instrument Tray
reserved. Printed in Germany.
Stryker and Howmedica logos are
registered trademarks of the Stryker
Corporation.
To ensure the best quality of its products
and their improvements Stryker reserves
the right to modify all or part of their
products.

Note:
Federal law (U.S.A) restricts this device
to sale by or on the order of a licensed
physician.

19
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insert, product label and/or user instructions before using any Stryker product. Products may not be available in all
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