The one step conical reamer is an optional instrument and has been developed to provide surgeons with another option to prepare the proximal canal of the trochanter using only one drilling step. When the Gamma3 Nail
180 is used, reaming of the subtrochanteric and diaphyseal region of the femoral cavity may not be required, particularly in elderly patients with wide medullary canals.
After skin incision, opening the entry point with the curved awl, and positioning of the guide wire as described above, the trocar or multi-hole trocar is inserted into the reamer sleeve to protect the soft tissue during insertion. Push the trocar (use center hole, if multi hole trocar is used) and sleeve assembly down over the 3mm guide wire to the tip of the trochanter (Fig. 29 and 30).
The one step conical reamer is a front and side cutting instrument and should be used with great care to ensure that the sharp edges of the reamer do not damage intact bone inadvertently.
Entry point optimization 进针点优化
The entry point can also be made without using the awl. A 3.2mm K-wire is placed through the tip of the trochanter.
If you find that the K-wire is not positioned in the optimal position, it may easily be corrected using a second K-wire in combination with the multi hole trocar.
The multi hole trocar has a special design for more precise insertion. In addition to the central hole, 4 other holes are located eccentrically at different distances from the center to easily revise insertion of the guiding K-wire in the proper position (Entry Point).
The trocar is then removed and the one step conical reamer is connected to the T-Handle and slid over the guide or K-wire to the tip of the trochanter. With gentle clockwise turning and pushing movements, the conical reamer will drill into the proximal part of the trochanter (Fig. 31 and 32) and prepare the canal for the proximal part of the Gamma3 Nail. The one step conical reamer stops when the correct depth is reached. If a 3.2mm K-wire was used it should be replaced by a guide wire now.