Surgical Technique

TRIGEN™ INTERTAN™ Intertrochanteric Antegrade Nail

Surgical Technique

As described by:
Andreas H. Ruecker, MD
Thomas A. Russell, MD
Roy W. Sanders, MD
Paul Tornetta, MD

Table of Contents
Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
INTERTAN System Case Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Design Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Nail Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Patient Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Incision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Entry Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Fracture Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Nail Length Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Preparation of the Medullary Canal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Target Device Assembly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Nail Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Anteversion Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
AP Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Guide Pin Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Lag Screw Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Single Lag Screw Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Integrated Interlocking Lag Screw Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Distal Locking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Nail Cap Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Nail Extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Catalog Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Nota Bene
The technique description herein is made available to the healthcare professional to illustrate the author’s
suggested treatment for the uncomplicated procedure. In the final analysis, the preferred treatment is that
which addresses the needs of the specific patient.

1
Introduction

INTERTAN™ Nails -
Designed for Stability
The TRIGEN™ INTERTAN nail was designed as a
trochanteric portal intramedullary nail especially
shaped for fractures of the proximal femur. The
INTERTAN system offers anatomically shaped
trapezoidal implants as opposed to conventional
circular shaped intramedullary nails.
The INTERTAN system offers an integrated
interlocking screw option to increase stability and
resistance to intra-operative and post-operative
femoral head rotation, thus eliminating excessive
sliding and the possibility of Z-effect. The INTERTAN
screw is a 4th generation intramedullary nail
combining the rotational stability of the original
RUSSELL-TAYLOR™ Reconstruction Nail with the
enhanced sliding and compression of the IMHS™
Intramedullary Hip Screw. The INTERTAN system
screw utilizes the best of both concepts.
The option of a single lag screw device placed in
the femoral head is available for rotationally stable
proximal femur fractures.
Devices in the proximal femur are at their greatest
stress levels when the hip is placed through its
flexion extension arc (ex: chair rise and climbing
stairs). During this event, the trapezoidal shape
of the INTERTAN system enhances stability of the
implant within the femur. In addition, the integrated
interlocking screw configuration imparts rotational
stability in the femoral head and neck segment, and
offers a greater resistance to cutout. With these
features, the INTERTAN system provides an innovative
treatment option for proximal femur fractures.

2
 This next generation nail in the TRIGEN™ system
provides these clear advantages:
Implants
• Additional strength and stability with a unique
integrated interlocking screw and trapezoidal
nail shape
• Improved resistance to femoral head rotation
and cutout
• Active compression achieved through a linear
motion without rotation
• Single subtrochanteric lag screw option for
stable fractures below the lesser trochanter
• Preloaded cannulated set screw converts
the construct to a fixed angle device
• The small proximal diameter of the nail
promotes preservation of the lateral wall
of the greater trochanter and gluteus
medius tendon
• Clothespin tip for stress modulation in the
femoral shaft
• Potential for improved patient mobility
and recovery

Instrumentation
• Familiar, easy to use, minimally invasive
TRIGEN instrumentation
• Anti-rotation bar maintains stability during
drilling and screw insertion
• Alignment guides for proper lag screw
placement in the femoral neck and head

3
INTERTAN™ System Case Examples

Case 1

Preoperative AP Preoperative Lateral

Postoperative AP Postoperative Lateral

12 Month AP 12 Month Lateral

4
Case 2

Preoperative AP

Postoperative AP Postoperative Lateral

5
 Design Features

Two-screw integrated interlocking provides:

• Improved resistance to femoral head rotation and cutout
• Active compression achieved through a linear motion without rotation

Preloaded cannulated set screw converts

4° Lateral offset for construct to a fixed angle device or allows
trochanteric for post operative sliding
insertion

Figure 8 cross-section
to improve resistance Trapazoidal nail shape provides
of cutout additional strength and stability in the
proximal femur during flexion extension
similar to hip stem prosthesis

Small proximal diameter of the nail

promotes preservation of the lateral
wall of the greater trochanter and
gluteus medius tendon

Distal slot for

static or 5mm of
dynamization and
rotational stability

Clothespin tip for

stress modulation Optional distal
in the femoral shaft diameters for
which reduces optimal fit in
stiffness that can femoral canal
cause thigh pain
and periprosthetic
fracture

6
Implant Specifications

11mm

32mm

Minor diameter tapers from 11-5.6mm

7.8mm

7mm

15.25mm

Integrated interlocking screws (sold together) 70-125mm

4°
15.25mm

28.3mm 16.25mm

18, 20cm

5mm

40mm / 18cm
10, 11.5, 13mm 60mm / 20cm

NOTE: These views are not to scale and should be used as a pictorial representation only.

7
Implant Specifications continued

16.25mm

28.3mm
15.25mm

26-46cm
2m AP
Bow

10, 11.5,
13mm

20mm
40mm

15mm

11mm

32mm

Minor diameter tapers from 11-5.6mm

Subtrochanteric lag screw

70-125mm

NOTE: These views are not to scale and should be used as a pictorial representation only.

8
Indications

INTERTAN nails are indicated for simple long

bone fractures; severely comminuted, spiral, long
oblique and segmental fractures; nonunions and
malunions; polytrauma and multiple fractures;
prophylactic nailing of impending pathologic
fractures; reconstruction following tumor resection
and grafting; bone lengthening and shortening;
subtrochanteric fractures; ipsilateral femoral
shaft/neck fractures; intertrochanteric fractures;
and intracapsular fractures.

9
Templates

Use the Smith & Nephew Preoperative INTERTAN™

nail templates to determine the appropriate neck
angle, nail length, nail diameter and proper screw
length. All INTERTAN nail templates are available 130°

Template
with 117% magnification to compensate for Lag Screw
Centerline

radiographic magnification. Please keep in mind

*12
that variations in magnification do occur.

5m
*12
0m

m
115

m
mm
110
mm
105
10

mm
0m
20mm

95

m
mm
90
mm
85
mm
80
10mm
cm
When selecting the appropriate nail size take all

mm
*75
mm
*70
mm
Top of Nail 0

aspects of the fracture into consideration.

16.3mm

15.2mm

10

15
65 55 45 35 25
60 50 40 30 mm

Shaft Diameter
5.0mm Gold Screw
10.0mm

RIGHT
18cm
11.5mm

13.0mm*

TFEL
20cm* 20

Lateral View A/P View

*Special Request

Orthopaedics
Smith & Nephew, Inc. mm 0 10 20 30 40 60 70 80 90 100 110 120 130 140 150 mm
50
1450 Brooks Road
Memphis, TN 38116
USA
117% Magnification
Telephone: 1-901-396-2121
For information: 1-800-821-5700 ™Trademark of Smith & Nephew. Reg. US Pat. & TM Off.
For orders and order inquiries: 1-800-238-7538
[Link] 02/06 7167-4098

TRIGEN™ INTERTAN Nail X-ray Template Set

Cat. No. 7167-4200

10
Patient Positioning

Place the patient in the supine position on a fracture

or radiolucent table with the unaffected limb
extended below the affected limb and trunk. Flex
the affected hip 15º-40º. Apply traction through
a skeletal traction pin or with the fracture table foot
holder. Adjust the affected limb for length and
rotation by comparison with the unaffected limb.
Check rotation by rotating the C-arm in line with
the femoral neck anteversion and then make the
appropriate correction. This is best checked by
visualizing the femoral anteversion proximally and
matching it with the correct rotation of the knee.

The lateral decubitus position may be selected in

certain fracture configurations at the surgeon’s
discretion.

For short nails only (not recommended for long nail

procedures), flex the hip and knee of the unaffected
extremity and place it in a leg holder. Abduction and
internal rotation of the hip allows unimpeded
fluoroscopic imaging.

11
Incision

Palpate the trochanter. Make a 3cm incision

approximately 2-3cm proximal to the greater
trochanter. Carry the incision through the
fascia. Do not damage the gluteal muscles
by excessive manipulation.

12
Entry Point

Assemble the entry portal tube to the entry portal

handle and insert the honeycomb. The tube assembly
is oriented so that the superior side of the bevel is
medial or lateral as desired. Advance the assembly
until it rests against the lateral aspect of the
greater trochanter.

TRIGEN™ Tip: Attaching suction to the entry portal

handle provides an unobstructed view of the entry
site, assists in blood evacuation, and minimizes
aerosolization of blood to the operative team.

Attach the 3.2mm guide pin to the mini-connector.

The entry point for the guide pin is in line with the
medullary canal in the ML view and 4º from center
in the AP view. Insert the guide pin through the
honeycomb and advance 2-3cm into the cortex
at the tip of the greater trochanter. Once proper
placement of the guide pin is achieved, remove
the honeycomb.

TRIGEN Tip: A two guide pin technique may be

used. The first pin is inserted through one of the
off-center holes in the honeycomb just lateral to
the tip of the greater trochanter. The honeycomb
is then rotated to access the definitive site of
precise portal placement. The second guide pin
can then be easily and accurately placed in the
definitive site.

Entry Portal Tube Entry Portal Handle 3.2mm Guide Pin Honeycomb Mini-Connector
Cat. No. 7167-4060 Cat. No. 7167-4092 Cat. No. 7167-4029 Cat. No. 7167-4075 Cat. No. 7163-1186

13
 Opening the Proximal Femur

Insert the 12.5mm entry reamer until it “clicks” into

the 16mm channel reamer. Attach the channel
reamer assembly to power for reaming of the
proximal section of the femur. Introduce the assembly
over the 3.2mm guide pin through the entry portal
tube and advance 1-2cm into bone. The reamer
assembly is then manipulated under image until the
shaft axis and intended path of the reamer form an
angle of approximately 4° in the AP view and is in
line with the center of the femoral canal in the ML
view. Caution should be taken not to over estimate
the angle, as too much of a lateral insertion angle
may make advancement of the nail more difficult.
Once the correct orientation is obtained, the reamer
assembly is advanced to full depth seated against
the entry portal tube. Remove the 12.5mm entry
reamer and guide pin, keeping the entry portal tube
and channel reamer in place.

TRIGEN™ Tip: View the channel reamer as a three

step process:
1. Capture the guide wire with 1st 10mm of channel
reamer insertion.
[Link] next 20mm of the channel reamer aligns for
varus, valgus, flexion, and extension alignment.
[Link] trajectory of reamer path from proximal
metaphysis into the medullary canal.

Note: Use caution not to insert the guide pin

in so deeply, that a false trajectory is made in
the proximal femur introducing a malalignment
at the fracture.

Note: If the entry portal tube is not used,

ensure that the channel reamer has reached
the level of the lesser trochanter.

12.5mm Entry 16mm Channel

Reamer Reamer
Cat. No. 7163-1116 Cat. No. 7167-4062

14
Fracture Reduction

Assemble the modular reducer and attach the

T-handle. Introduce the assembly through the
channel reamer and entry portal tube. Use the
reducer to manipulate the proximal fragment
and reduce the fracture. Insert the reducer to the
level of the distal epiphyseal scar once the distal
fragment has been captured.

TRIGEN™ Tip: If the fracture is severely displaced,

use the curved tip of the reducer to direct the
3.0mm x 1000mm ball tip guide rod into the distal
fragment of the femur. Under fluoroscopy, stop the
reducer as it approaches the fracture site. Pass
the guide rod through the reducer until the tip
of the guide rod can be visualized at the end
of the curved reducer. Rotate the reducer and
direct the guide rod to capture the distal fragment
then advance the reducer into the distal fragment.
The gripper is useful in holding onto the guide rod
during insertion, proper placement, and removal.

Reducer T-handle 3.0mm x 1000mm Gripper

Cat. No. 7167-4077 Cat. No. 7167-4076 Ball Tip Guide Rod Cat. No. 7167-4080
Cat. No. 7163-1626

15
Guide Rod Placement

Insert the 3.0mm ball-tipped guide rod through

the reducer and into the distal femur. The guide
rod should be placed center-center in the shaft of
the femur in the AP and ML views stopping in the
region of the distal epiphyseal scar. This minimizes
the chance of eccentric anterior placement of the
nail in osteopenic femurs.

3.0mm x 1000mm Reducer

Ball Tip Guide Rod Cat. No. 7167-4077
Cat. No. 7163-1626

16
Nail Length Measurement

If a long nail has been chosen, it will be necessary

to measure for nail length. Confirm the distal tip of
the 3.0mm x 1000mm ball tip guide rod is located
at the desired position in the distal femur. Slide the
ruler over the proximal end of the guide rod.
Advance the open end of the ruler through the
channel reamer and entry portal tube. The tip of the
ruler should be at the level of the greater trochanter.
Read the nail length from the calibrations exposed
at the other end of the ruler.

3.0mm x 1000mm Ruler

Ball Tip Guide Rod Cat. No. 7167-4079
Cat. No. 7163-1626

17
Preparation of Medullary Canal

Canal preparation is dependent upon surgical

preference. If diaphyseal reaming is planned, use
progressive reamers over the guide rod through the
channel reamer and entry portal tube. Sequentially
ream in 0.5mm increments to approximately 1mm
larger than the chosen nail diameter. The obturator
may be used to ensure the guide rod stays in
position during reaming. Periodically move the
reamer back and forth in the femoral canal to clear
debris from the cutting flutes of the reamer.

TRIGEN™ Tip: The obturator is used during sequential

reaming to maintain the position of the guide rod in
the canal. The holes in the black obturator head can
be used to hold the exposed end of the guide rod as
reamer removal begins. The obturator shaft can then
be inserted into the cannulation of the reamer to
continue holding the guide rod position.

Note: The channel reamer will not accommodate

reamer heads larger than 12.5mm.

Obturator Reamer Shaft Reamer Set

Cat. No. 7167-4078 (Optional) (Optional)
Cat. No. 7163-1192 Cat. No. 7167-1212

18
Target Device Assembly

Select the appropriate radiolucent drill guide drop

based upon the neck angle chosen and attach
the drop to the drill guide handle. Confirm the
pre-loaded cannulated set screw does not obstruct
the lag screw hole in the nail. Insert the 7/16 guide
bolt into the drill guide handle and attach the nail
using the guide bolt wrench with T-handle. Ensure
that the guide bolt is properly seated and threaded
into the nail. Any nail incorrectly attached will not
accurately target. Verify targeting accuracy by
inserting the lag screw drill sleeve into the drill guide
and confirm the 11mm lag screw drill passes easily
through the nail. Once the correct nail assembly has
been verified remove the drill sleeve and attach the
Impactor onto the drill guide to insert the nail.

7/16 Guide Bolt Guide Bolt Wrench T-handle Impactor Drill Guide Drop
Cat. No. 7167-4071 Cat. No. 7163-1140 Cat. No. 7167-4076 Cat. No. 7167-4081 Cat. No. 7167-400x

19
Nail Insertion

Verify proper fracture reduction. Advance the nail

over the guide rod with the drill guide in the lateral
position and carefully seat in the proximal femur.
Final nail position is achieved with a gentle
impaction force applied by the slotted hammer
after confirmation of proper anteversion and
AP alignment.

Select the appropriate radiolucent drill guide drop

based upon the neck angle chosen and attach
the drop to the drill guide handle.

TRIGEN™ Tip: For long nails, orient the nail and

guide 90º anteriorly. Advance the nail over the
guide rod until the nail taper is reached and then
rotate the guide to the lateral position.

Drill Guide Handle Slotted Hammer

Cat. No. 7167-4001 Cat. No. 7167-4082

20
Anteversion Alignment

Anteversion alignment is achieved using the

radio-opaque embedded wire in the drill guide
handle. Position the C-Arm for an anteverted
lateral image. Rotate the drill guide until both the
nail and wire are centered within the femoral head.
This may also require adjustment of the C-Arm.

Drill Guide Handle

Cat. No. 7167-4001

21
AP Alignment

Rotate the C-Arm to the AP position. Attach the

alignment tower to the drill guide and insert the
alignment arm. Verify the markings on the alignment
arm match the operative side. Use the C-Arm to
position the drill guide so the alignment arm and
the center of the lag screw hole in the nail are in
line with the femoral head. The alignment arm
facilitates visualization of the central axis of the
lag screw. Center-center alignment applies to both
the single subtrochanteric lag screw and the 11.0mm
lag screw of the integrated interlocking screws.

Alignment Tower Alignment Arm

Cat. No. 7167-4018 Cat. No. 7167-4066

22
Final Seating of the Nail

Remove the guide rod prior to the last 2cm of

final seating. Confirm the nail is in the desired
position and exert a gentle impaction force with
the hammer to fully seat the nail.

Note: The trapezoidal cross section of the nail

helps control rotation during insertion similar to
the press fit of uncemented hip stem techniques.

Note: If excessive impaction force was necessary,

check to make sure the guide bolt is still tight
and the set screw has not migrated into the lag
screw hole.

If the nail fails to advance sufficiently, use biplanar

imaging of the nail tip and the fracture zone to
identify the source of impingement. Additional
reaming may be required, especially in the
proximal metphyseal diaphyseal junction. If the
16mm channel reamer was previously used, use
the 17mm channel reamer. In young strong bone,
a narrow proximal metaphyseal to diaphyseal
transition may require sequential flexible canal
reaming over the guide wire to facilitate
nail insertion.

Note: Since the channel reamer must be removed

for reaming over 12.5mm, exercise caution not to
ream out the lateral cortex in the proximal femur.

17mm Channel
Reamer
Cat. No. 7167-4063

23
Guide Pin Insertion

Insert the adjustable lag screw drill sleeve and the

4.0mm drill sleeve trocar into the drill guide. Firmly
press the trocar tip into the skin. Use this mark to
make a small incision down to bone. Advance the
drill sleeve and drill sleeve trocar through the
incision. Verify the lag screw sleeve locks into the
drill guide.

Note: Both sleeves should rest gently against

bone. If the drill sleeves are pushed aggressively
in position the drill guide may deflect.

Note: The lag screw drill sleeve is adjustable.

The “0” setting will accommodate most patients.

Confirm the desired anteversion with the C-Arm

in the lateral position.

Lag Screw 4.0mm Sleeve

Drill Sleeve Trocar
Cat. No. 7167-4023 Cat. No. 7167-4072

24
Make sure that the trocar sleeve is gently resting
against bone and insert the 4.0mm long AO pilot
drill. Open the lateral cortex under power. Remove
the drill bit and replace the trocar sleeve with
the lag screw 3.2mm guide pin sleeve. Advance
the 3.2mm guide pin through the guide pin sleeve
while maintaining the correct anteversion. Final
positioning of the guide pin should be done with
the C-Arm in the AP plane. Insert the guide pin
until the tip reaches the optimal tip-to-apex
distance (TAD). Reconfirm the final placement
of the pin in both planes.

TRIGEN™ Tip: Utilize the 4.0mm drill sleeve trocar to

optimize drill position in the lateral cortex and help
prevent cephalad malposition of the guide pin.

Note: Do not use the trocar sleeve to read guide pin

markings. The 3.2mm guide pin sleeve must be
seated within lag screw drill sleeve.

4.0mm Long AO 3.2mm Guide Pin Lag Screw 3.2mm

Pilot Drill Cat. No. 7167-4029 Guide Pin Sleeve
Cat. No. 7164-1121 Cat. No. 7167-4032

25
Lag Screw Measurement

Read the calibrations off the guide pin for lag screw
measurement. Alternatively, lag screw measurement
may be obtained by inserting the lag screw length
gauge over the guide pin until it sits flush with
the end of the lag screw 3.2mm guide pin sleeve.
Confirm the guide pin sleeve is seated flush within
the lag screw drill sleeve for an accurate
measurement. Lag screw measurement is
determined by lining up the end of the guide pin
with the calibrations on the length gauge.

Note: The lag screw measurement is independent

of the proximity of the drill sleeve to the lateral
cortex of the femur.
At this point in the procedure it is necessary to
determine if a single lag screw or an integrated
interlocking lag screw will be chosen. Once you
commit to a single lag screw technique
you cannot use the integrated interlocking
screw technique.

The single lag screw steps are tabbed in Blue.

The integrated interlocking screw steps are

tabbed in Green.

Lag Screw
Length Gauge
Cat. No. 7167-4058

26
Single Lag Screw Insertion

Single Lag Screw Insertion

Single Lag Screw Drilling
Confirm that the guide pin tip is 5mm from
subcondular bone for adequate screw depth. Drill
over the guide pin under image using the 11.0mm
lag screw drill. Confirm the guide pin is not being
forced forward. Drill until the lag screw drill reaches
the measured guide pin depth. This will be indicated
by the markings on the shaft of the lag screw drill.
Care should be taken to ensure that orientation of
the drill guide handle is not altered. Markings on the
lag screw drill reference the face of the drill sleeve.

TRIGEN™ Tip: Use the obturator to maintain

the position of the guide pin during lag screw
drill removal.

Lag Screw Selection

If compression is not needed then select a lag
screw length equal to the measurement taken from
the drilling depth. For example, if the drilling depth
was 100mm then select a 100mm lag screw.

If compression is needed then select a lag screw

length equal to the measurement taken from the
guide pin minus the desired amount of compression.
For example, if the drilling depth was 100mm and up
to 5mm of compression is needed, then select a
95mm lag screw. By selecting a 90mm lag screw a
maximum of 10mm of compression can be achieved.

Note: It is not recommended to exceed 10mm

of compression.

11mm Lag Screw Subtroch Lag T-handle

Drill screwdriver Cat. No. 7167-4076
Cat. No. 7167-4008 Cat. No. 7167-4068

27
 Single Lag Screw Insertion
Single Lag Screw Insertion
continued

Lag Screw Insertion

Without Compression
Attach the selected INTERTAN™ Subtrochanteric
Lag Screw to the subtroch lag screwdriver.
Thread the compressing dial onto the end of
the driver until the “0” mark is visible. Attach the
T-handle and insert the driver assembly into the
lag screw drill sleeve. Advance the driver by
rotating it clockwise until the dial is flush against
the drill sleeve. At final seating, the T-handle must
be positioned perpendicular or parallel to the drill
guide to properly orient the lag screw.

INTERTAN Lag Screw Insertion

With Compression
Attach the selected subtrochanteric lag screw to
the subtroch lag screwdriver.

Option #1: 5mm of Compression

If the lag screw selected is 5mm less than what
was drilled for, thread the compressing dial onto
the end of the driver until the “5” mark is visible.

Option #2: 10mm of Compression

If the lag screw selected is 10mm less than what
was drilled for, thread the compressing dial onto
the end of the driver until the “10” mark is visible.

Attach the T-handle and insert the driver assembly

into the lag screw drill sleeve. Advance the driver
by rotating it clockwise until the compressing dial
is flush against the drill sleeve. At final seating, the
T-handle must be positioned perpendicular or parallel
to the drill guide to properly orient the lag screw.

T-handle Subtroch Lag Compressing Dial

Cat. No. 7167-4076 Screwdriver Cat. No. 7167-4069
Cat. No. 7167-4068

28
 Single Lag Screw Insertion
Compression is achieved by rotating the
compressing dial clockwise until desired
compression is achieved or the “0” mark on
the subtroch lag driver is visible.

Note: The red marking on the driver signifies

that the compression limit has been reached.

Locking Set Screw

To prevent sliding, tighten the set screw firmly
using the set screwdriver and T-handle assembly.
To permit sliding, reverse the set screw ¼ turn
counterclockwise once the set screw is tightened.
Screw design prevents medial screw migration
into the femoral head.

Confirm the set screw is engaged in a migration

limiting slot on the lag screw by gently turning the
T-handle. If turning the T-handle is limited, then the
set screw is properly engaged.

T-handle Subtroch Lag Compressing Dial

Cat. No. 7167-4076 Screwdriver Cat. No. 7167-4069
Cat. No. 7167-4068

29
 Integrated Interlocking Lag Screw Insertion
Integrated Interlocking Lag Screw Insertion

Compression Screw Preparation

Attach the 7.0mm compression screw starter drill
to power and perforate the lateral cortex beneath
the lag screw 3.2mm guide pin sleeve to prepare
the bone for the head of the compression screw.
Advance the drill until the built in positive stop
abuts the guide pin sleeve. Remove the starter drill.

Note: It is imperative to abut the starter drill prior

to drilling for the compression screw. The starter
drill prepares the lateral cortex for the compression
screw head which is larger than its shaft. Failure to
complete this step may cause inefficient compression
and/or cephalad malposition.

Attach the 7.0mm compression screw drill to power and

insert it into the same hole as the starter drill. Advance
the drill under fluoroscopy to a depth 5mm less than the
guide pin depth. The markings on the compression
screw are read from the face of the lag screw drill sleeve.

Remove the compression screw drill and replace

it with the anti-rotation bar. The anti-rotation bar
should be introduced using hand force only. If the
starter drill has not been sufficiently used, the
lateral cortex may deflect the anti-rotation bar. If
deflection occurs, reuse the starter drill to clear
away the bone at the nail interface to facilitate
anti-rotation bar insertion.

Note: The anti-rotation bar provides stability of the

head and neck segment during lag screw drilling.

INTERTAN™ Lag Screw Drilling

Drill over the guide pin using the 11.0mm lag screw
drill. Confirm under image the guide pin is not being
forced forward beyond the desired depth. Markings on
the lag screw drill reference the face of the drill sleeve
and confirm guide pin depth. Care should be taken to
ensure orientation of the drill guide handle is not altered.

TRIGEN™ Tip: Use the obturator to maintain the

position of the guide pin during drilling.

7.0mm Compression 7.0mm Compression Anti-Rotation Bar

Screw Starter Drill Screw Drill Cat. No. 7167-4073
Cat. No. 7167-4070 Cat. No. 7167-4034

30
 Integrated Interlocking Lag Screw Insertion
INTERTAN™ Lag Screw Selection
If compression is not needed then select the lag
screw length that is equal to the measurement taken
from the drilling depth. For example, if the drilling
depth was 100mm, then select a 100mm Lag Screw.

If compression is needed then select the lag screw

length that is equal to the measurement taken from
the drilling depth minus the desired amount of
compression. For example, if the drilling depth was
100mm and up to 5mm of compression is needed,
then select a 95mm lag screw. By selecting a 90mm
lag screw, a maximum of 10mm of compression can
be achieved. The INTERTAN lag screw will be
packaged with the 7.0mm compression screw. The
compression screw is 5mm shorter than the lag
screw.

Note: It is not recommended to exceed 10mm

of compression.

INTERTAN Lag Screw Insertion

Without Compression
Attach the selected INTERTAN lag screw to the lag
screwdriver. Insert the driver assembly into the lag
screw drill sleeve. Gently advance the driver
through the drilled hole.

Rotate the driver, inserting the screw until the “0”

mark on the driver is in line with the face of the lag
screw drill sleeve. At final seating, the T-handle of the
lag screwdriver must be perpendicular to the drill
guide to allow for the removal of the anti-rotation bar.

Remove the anti-rotation bar. Next attach the

compression screw to the compression screw
hexdriver. Once the compression screw is properly
secured, attach the T-handle to the hexdriver. Advance
the compression screw by rotating the T-handle
clockwise until the blue line on the driver shaft is
aligned with the face of the lag screw drill sleeve.

Lag Screwdriver Compression T-handle

Cat. No. 7167-4067 Screw Hexdriver Cat. No. 7167-4076
Cat. No. 7167-4035

31
 Integrated Interlocking Lag Screw Insertion
Integrated Interlocking Lag Screw Insertion
continued

TRIGEN™ Tip: Even if no compression was planned

2-3mm of compression can be achieved by rotating
the compression screw T-handle until the red line
on the lag screwdriver becomes visible. Do not
compress past the red line.

TRIGEN Tip: If additional compression is needed

then remove the compression screw hexdriver and
assemble the compressing dial onto the lag
screwdriver. Thread the compressing dial until is
abuts the lag screw drill sleeve. Gently rotate the
compressing dial clockwise under image until
desired compression is achieved. A maximum of
5mm of compression may be achieved.

INTERTAN™ Lag Screw Insertion

With Compression
Attach the selected INTERTAN lag screw to the lag
screwdriver. Insert the driver assembly into the
lag screw drill sleeve. Gently advance the driver
through the drilled hole.

Note: Release any traction on the fracture to

allow compression.

Option #1: 5mm of Compression

Rotate the driver, inserting the screw until the “5”
mark on the driver is in line with the face of the
lag screw drill sleeve. At final seating, the T-handle
of the lag screwdriver must be perpendicular
to the drill guide to allow for the removal of the
anti-rotation bar.

Option #2: 10mm of Compression

Rotate the driver, inserting the screw until the “10”
mark on the driver is in line with the face of the
lag screw drill sleeve. At final seating, the T-handle
of the lag screwdriver must be perpendicular
to the drill guide to allow for the removal of the
anti-rotation bar.

Anti-Rotation Bar Lag Screwdriver

Cat. No. 7167-4073 Cat. No. 7167-4067

32
 Integrated Interlocking Lag Screw Insertion
Remove the anti-rotation bar. Next attach the
compression screw to the compression screw
hexdriver. Once the compression screw is properly
secured, attach the T-handle to the hexdriver.
Advance the compression screw by rotating the
T-handle clockwise until the blue line on the driver
shaft is aligned with the face of the lag screw
drill sleeve. At this point the compression screw is
seated within the nail and compression can begin.

Continue to rotate the T-handle to linearly compress

the fracture. Rotating the T-handle will cause the
gear mechanism of the integrated interlocking screws
to migrate the lag screwdriver back as compression
occurs. When the blue line below the “0” mark on the
lag screwdriver becomes visible, it is recommended
to stop compression.

TRIGEN™ Tip: An additional 2-3mm of compression

can be achieved by rotating the compression screw
T-handle until the red line on the lag screwdriver
becomes visible. Once the red line becomes visible,
the compression limit has been reached.

Locking Set Screw

To prevent sliding, tighten the preassembled set
screw firmly using the set screwdriver and T-handle
assembly.

Note: The integrated interlocking lag screw is

incapable of superior migration.

Note: The INTERTAN™ subtrochanteric lag screw is

incapable of superior migration only if the set screw
is engaged.

Compression Set Screwdriver

Screw Hexdriver Cat. No. 7166-5014
Cat. No. 7167-4035

33
Distal Locking Short Nails

Insert the 4.0mm drill sleeve into the 9.0mm drill

sleeve and place this assembly through the drill
guide. Make a stab incision and seat the drill sleeve
assembly to bone. Drill through both cortices using
the 4.0mm long AO pilot drill. The screw length
can be determined using the drill bit calibrations
measured against the 4.0mm drill sleeve or the
screw depth gauge. Attach the appropriate length
internal captured 5.0mm screw to the medium
hexdriver. Attach the T-handle to the hexdriver and
insert the screw. Targeted static (proximal) and
dynamic (distal) locking options are available.

TRIGEN™ Tip: Use the screwdriver release handle

through the T-handle to release the hexdriver from
the screw.

4.0mm Drill Sleeve 9.0mm Drill Sleeve 4.0mm Long AO Screw Depth Gauge Medium Hexdriver
Cat. No. 7167-4083 Cat. No. 7163-1152 Pilot Drill Cat. No. 7163-1189 Cat. No. 7163-1066
Cat. No. 7164-1121

34
Distal Locking Long Nails

Distal locking in the long nail will require a free hand

technique. Use the screw length sleeve, 4.0mm
short AO pilot drill and the short hexdriver for this
technique. Once “perfect circles” are established,
make a stab incision. The short pilot drill is used
under power to drill through the locking holes in the
nail. The screw length can be determined using the
drill bit calibrations measured against the 4.0mm
drill sleeve or the screw depth gauge. Attach the
appropriate length screw to the short hexdriver,
connect the T-handle and insert the screw until it
is fully seated.

Screw Length 4.0mm Short AO Short Hexdriver

Sleeve Pilot Drill Cat. No. 7163-1068
Cat. No. 7167-4085 Cat. No. 7164-1123

35
Nail Cap Insertion

It is recommended to use a nail cap to close the

proximal end of the nail if osseous ingrowth is
a concern. Attach the nail cap to the medium
hexdriver and then attach the T-handle. Insert
the assembly into the incision near the greater
trochanter and insert the end cap rotating the
T-handle clockwise.

Note: The nail cap should be fully seated and flush

within the nail at final seating.

Medium Hexdriver Nail Cap

Cat. No. 7163-1066 Cat. No. 7167-5040

36
Nail Extraction Technique

Through a small incision, remove any distal locking

screws using the short hex driver. Make an incision
over the proximal end of the nail. Under fluoroscopy,
place a 3.2mm guide pin into the driving end of the
nail. A mallet may be used to insert the guide pin,
but usually power equipment is available and can
be used for percutaneous placement.

When the guide pin is in the nail, make a one

inch incision about the guide pin and advance the
12.5mm entry reamer over the pin to remove the
osseous ingrowth overlying the nail. Note that
the tip of the reamer is straight for approximately
one-half inch before flaring out. It is this portion
of the reamer that enters the nail.

After reaming, remove the reamer and the guide pin

and insert the 3.0mm ball tip guide rod. Attach the
extractor to the impactor and tighten, then thread
the extractor into the nail (with the guide rod in
place). Place the guide bolt wrench shaft into the
impactor slot and turn clockwise until the impactor is
securely engaged into the nail.

After the impactor is securely engaged in the nail,

remove the remaining lag screw.

Single Lag Screw Removal

Make a small incision at the lateral aspect of
the INTERTAN™ subtrochanteric lag screw and remove
any osseous ingrowth that may have formed into
the screw. Attach the lag screwdriver to the lag
screw. Confirm the lag screwdriver is fully seated and
the lag screw is captured. Remove the screw rotating
the T-handle counterclockwise.

12.5mm Entry 3.2mm Guide Pin IMHS™ CP Nail

Reamer Cat. No. 7167-4029 Extractor
Cat. No. 7163-1116 Cat. No. 7168-7111

37
Nail Extraction Technique continued

Integrated Interlocking
Lag Screw Removal
Make a small incision at the lateral aspect of the
integrated interlocking lag screw and remove any
osseous ingrowth that may have formed into the
screws. Attach the long INTERTAN™ hexdriver to the
inferior compression screw. Confirm the hexdriver
is fully seated and remove the screw rotating the
T-handle counterclockwise. Once the compression
screw has been removed attach the lag screwdriver
to the superior lag screw and remove the screw
rotating the T-handle counterclockwise.

Confirm that all locking screws have been removed

and remove the nail. Gently backslap the impactor
with the slotted hammer if needed.

Use extreme caution not to exert any side loads on

the impactor extractor assembly. Excessive pulling
and pushing on the end of the impactor handle
could result in premature failure of the extractor
device. In the event of extractor, re-tighten the
gripper adjacent to the impactor and proceed with
the extraction.

Recommended usage for the extractor: 7-10 times

then replace.

38
An Alternative Method for Extraction

Jamming the Guide Rods

Utilizing two guide rods, one 3.0mm ball tip and
one 2.0mm smooth guide rod, advance the ball tip
guide rod past the end of the nail then insert the
smooth guide rod in a similar manner, past the tip
of the nail. Once both rods are in place, attach the
gripper to the end of the ball tipped guide rod and
pull back to wedge the ball tip with the smooth guide
rod and the end of the nail. Backslap against the
gripper to remove the nail.

Cat. No. Description

11-5120 2.0mm x 700mm smooth
7163-1626 3.0mm x 1000mm ball tip
7111-8280 2.0mm x 900mm smooth
7111-8202 3.0mm x 900mm ball tip
11-2069 3.0mm x 900mm ball tip

Note: Other items that may be helpful in removal

are as follows:

Cat. No. Description

115074 Large Extractor Hook
115073 Small Extractor Hook
914659 Small Easy Out
914658 Large Easy Out

39
Set Maps

INTERTAN™ Base Tray

Cat. No. 7167-4020

TRIGEN™ Instrument Tray

Cat. No. 7167-4021

40
Catalog Information – Screws
Cat. No. Description Qty.
7167-1210 TRIGEN™ 5.0mm Internal Captured 25mm-50mm Screw Set
7164-2225 Internal Hex Captured Screw 5.0mm x 25mm 1
7164-2230 Internal Hex Captured Screw 5.0mm x 30mm 3
7164-2235 Internal Hex Captured Screw 5.0mm x 35mm 2
7164-2240 Internal Hex Captured Screw 5.0mm x 40mm 1
7164-2245 Internal Hex Captured Screw 5.0mm x 45mm 1
7162-2250 Internal Hex Captured Screw 5.0mm x 50mm 1

7167-6032 INTERTAN™ Lag/Compression Screw Kit Set

7167-2030 INTERTAN Compression Screw 30mm 1
7167-7080 INTERTAN Lag/Comp Screw Kit 80mm x 75mm 1
7167-7085 INTERTAN Lag/Comp Screw Kit 85mm x 80mm 2
7167-7090 INTERTAN Lag/Comp Screw Kit 90mm x 85mm 2
7167-7095 INTERTAN Lag/Comp Screw Kit 95mm x 90mm 2
7167-7100 INTERTAN Lag/Comp Screw Kit 100mm x 95mm 2
7167-7105 INTERTAN Lag/Comp Screw Kit 105mm x 100mm 1
7167-7110 INTERTAN Lag/Comp Screw Kit 110mm x 105mm 1
7167-7115 INTERTAN Lag/Comp Screw Kit 115mm x 110mm 1

7167-2000 INTERTAN Subtrochanteric Lag Screw Set

7167-8005 INTERTAN Subtrochanteric Lag Screw 105mm 1
7167-8010 INTERTAN Subtrochanteric Lag Screw 100mm 1
7167-8011 INTERTAN Subtrochanteric Lag Screw 110mm 1
7167-8015 INTERTAN Subtrochanteric Lag Screw 115mm 1
7167-8080 INTERTAN Subtrochanteric Lag Screw 80mm 1
7167-8085 INTERTAN Subtrochanteric Lag Screw 85mm 2
7167-8090 INTERTAN Subtrochanteric Lag Screw 90mm 3
7167-8095 INTERTAN Subtrochanteric Lag Screw 95mm 3

41
Catalog Information – Nails

Short
Cat. No. Description Qty.

7167-1250 INTERTAN™ 125° 10mm & 11.5mm x 18cm Set

7167-5201 INTERTAN 10mm x 18cm 125° 1
7167-5202 INTERTAN 11.5mm x 18cm 125° 1

7167-1350 INTERTAN 130° 10mm & 11.5mm x 18cm Set

7167-5207 INTERTAN 10mm x 18cm 130° 1
7167-5208 INTERTAN 11.5mm x 18cm 130° 1

Long
Cat. No. Description Qty.

7167-1251 INTERTAN 125° 10mm x 34-40cm Set

7167-5221 INTERTAN 10mm x 34cm 125° Left Lime 1
7167-5222 INTERTAN 10mm x 34cm 125° Right Rose 1
7167-5223 INTERTAN 10mm x 36cm 125° Left Lime 1
7167-5224 INTERTAN 10mm x 36cm 125° Right Rose 1
7167-5225 INTERTAN 10mm x 38cm 125° Left Lime 1
7167-5226 INTERTAN 10mm x 38cm 125° Right Rose 1
7167-5227 INTERTAN 10mm x 40cm 125° Left Lime 1
7167-5228 INTERTAN 10mm x 40cm 125° Right Rose 1

7167-1351 INTERTAN 130° 10mm x 34-40cm Set

7167-5265 INTERTAN 10mm x 34cm 130° Left Lime 1
7167-5266 INTERTAN 10mm x 34cm 130° Right Rose 1
7167-5267 INTERTAN 10mm x 36cm 130° Left Lime 1
7167-5268 INTERTAN 10mm x 36cm 130° Right Rose 1
7167-5269 INTERTAN 10mm x 38cm 130° Left Lime 1
7167-5270 INTERTAN 10mm x 38cm 130° Right Rose 1
7167-5271 INTERTAN 10mm x 40cm 130° Left Lime 1
7167-5272 INTERTAN 10mm x 40cm 130° Right Rose 1

42
Long continued
Cat. No. Description Qty.
7167-1252 INTERTAN™ 125° 11.5mm x 34-40cm Set
7167-5243 INTERTAN 11.5mm x 34cm 125° Left Lime 1
7167-5244 INTERTAN 11.5mm x 34cm 125° Right Rose 1
7167-5245 INTERTAN 11.5mm x 36cm 125° Left Lime 1
7167-5246 INTERTAN 11.5mm x 36cm 125° Right Rose 1
7167-5247 INTERTAN 11.5mm x 38cm 125° Left Lime 1
7167-5248 INTERTAN 11.5mm x 38cm 125° Right Rose 1
7167-5249 INTERTAN 11.5mm x 40cm 125° Left Lime 1
7167-5250 INTERTAN 11.5mm x 40cm 125° Right Rose 1

7167-1352 INTERTAN 130° 11.5mm x 34-40cm Set

7167-5287 INTERTAN 11.5mm x 34cm 130° Left Lime 1
7167-5288 INTERTAN 11.5mm x 34cm 130° Right Rose 1
7167-5289 INTERTAN 11.5mm x 36cm 130° Left Lime 1
7167-5290 INTERTAN 11.5mm x 36cm 130° Right Rose 1
7167-5291 INTERTAN 11.5mm x 38cm 130° Left Lime 1
7167-5292 INTERTAN 11.5mm x 38cm 130° Right Rose 1
7167-5293 INTERTAN 11.5mm x 40cm 130° Left Lime 1
7167-5294 INTERTAN 11.5mm x 40cm 130° Right Rose 1

Disposables
Cat. No. Description Qty.
7167-1200 INTERTAN™ Disposable Set
7163-1121 4.0mm Long AO Pilot Drill (4.0mm x 333mm) 2
7163-1123 4.0mm Short AO Pilot Drill (4.0mm x 161mm) 2
7163-1626 3.0mm x 1000mm Ball Tip Guide Rod 2
7167-4029 3.2mm Guide Pin (3.2mm x 343mm) 3

43
Catalog Information – Instruments – INTERTAN™ System

INTERTAN Instrument Set

Cat. No. 7167-4011

Tray Outer Case

Cat. No. 7112-9401

Lid for Outer Case

(Shown with Case)
Cat. No. 7112-9402

Set Screwdriver
Cat. No. 7166-5014

Drill Guide Handle

Cat. No. 7167-4001

125° Radiolucent Drill Guide Drop

Cat. No. 7167-4002

130° Radiolucent Drill Guide Drop

Cat. No. 7167-4003
(135° Special Order)

11mm Lag Screw Drill

Cat. No. 7167-4008

Lag Screw Tap

Cat. No. 7167-4009

Alignment Tower
Cat. No. 7167-4018

INTERTAN Instrument Tray

Cat. No. 7167-4020

Lag Screw Drill Sleeve

Cat. No. 7167-4023

Lag Screw 3.2mm Guide Pin Sleeve

Cat. No. 7167-4032

44
7.0mm Compression Screw Drill
Cat. No. 7167-4034

Compression Screw Hexdriver

Cat. No. 7167-4011

Lag Screw Length Gauge

Cat. No. 7167-4058

16mm Channel Reamer

Cat. No. 7167-4062

17mm Channel Reamer

Cat. No. 7167-4063

Alignment Arm
Cat. No. 7167-4066

Lag Screwdriver
Cat. No. 7167-4067

Subtroch Lag Screwdriver

Cat. No. 7167-4068

Compressing Dial
Cat. No. 7167-4069

7.0mm Compression Screw

Starter Drill
Cat. No. 7167-4070

7/16 Guide Bolt

Cat. No. 7167-4071

4.0mm Drill Sleeve Trocar

Cat. No. 7167-4072

Anti-Rotation Bar
Cat. No. 7167-4073

IMHS™ CP Nail Extractor

Cat. No. 7168-7111

45
Catalog Information – Instruments – TRIGEN™ System

TRIGEN System Base Set

Cat. No. 7167-4021

Tray Outer Case

Cat. No. 7112-9401

Lid for Outer Case

(Shown with Case)
Cat. No. 7112-9402

4.7mm Medium Hexdriver

Cat. No. 7163-1066

4.7mm Short Hexdriver

Cat. No. 7163-1068

12.5mm Entry Reamer

Cat. No. 7163-1116

Guide Bolt Wrench

Cat. No. 7163-1140

9mm Drill Sleeve

Cat. No. 7163-1152

Multipurpose Driver Not Shown

Cat. No. 7163-1161

Mini Connector
Cat. No. 7163-1186

Screw Depth Gauge

Cat. No. 7163-1189

Cannulated Awl
Cat. No. 7167-4000

46
Entry Portal Tube
Cat. No. 7167-4060

T-handle Trocar
Cat. No. 7167-4074

Honeycomb
Cat. No. 7167-4075

Reducer
Cat. No. 7167-4077

Obturator
Cat. No. 7167-4078

Ruler
Cat. No. 7167-4079

Gripper
Cat. No. 7167-4080

Impactor
Cat. No. 7167-4081

Slotted Hammer
Cat. No. 7167-4082

4.0mm Drill Sleeve

Cat. No. 7167-4083

Screwdriver Release Handle

Cat. No. 7167-4084

Screw Length Sleeve

Cat. No. 7167-4085

T-handle
Cat. No. 7167-4076

47
Catalog Information – Replacement Parts
Cat. No. Description Qty.
7167-4086 Subtroc Lag Screw Hexdriver Rod 1
7167-4087 Lag Wrench Retaining Rod Assembly 1
7167-4088 Compression Screw Hexdriver Shaft 1
7163-1169 Short Hexdriver Screw Retaining Shaft 1
7163-1167 Medium Hexdriver Screw Retaining Shaft 1
7163-1165 Long Hexdriver Screw Retaining Shaft 1
7163-1165 Multipurpose Driver Retaining Shaft 1
7167-4090 Tissue Protector Locking Collar 1

TRIGEN™ Reamer Set (optional)

Cat. No. Description Qty.
7167-1212 TRIGEN Reamer Set
7111-8200 Sculptor Flexible Reamer 1
7111-8232 9.0mm Reamer Head 1
7111-8233 9.5mm Reamer Head 1
7111-8234 10.0mm Reamer Head 1
7111-8235 10.5mm Reamer Head 1
7111-8236 11.0mm Reamer Head 1
7111-8237 11.5mm Reamer Head 1
7111-8238 12.0mm Reamer Head 1
7111-8239 12.5mm Reamer Head 1
7111-8240 13.0mm Reamer Head 1
7111-8241 13.5mm Reamer Head 1
7111-8242 14.0mm Reamer Head 1
7163-1130 Flexible Reamer Extender 1

48
Notes
Orthopaedics
Smith & Nephew, Inc. [Link]
1450 Brooks Road
Memphis, TN 38116
USA

Telephone: 1-901-396-2121
Information: 1-800-821-5700
Orders/Inquiries: 1-800-238-7538

™Trademark of Smith & Nephew. Reg. US Pat. & TM Off. 30013103014a 7118-1065 4/06