Cable Ready Greater Trochanteric Reattachment Surgical Technique 97 2232 107 00 Rev 3 07 2010

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Cable-Ready®

Greater

Trochanteric

Reattachment

Surgical Technique

1

Cable-Ready Greater Trochanteric Reattachment Surgical Technique

Cable-Ready

Greater Trochanteric

Reattachment Surgical

Technique

Table of Contents

Surgical Technique for Cable-Ready Short GTR Plate

Cable Insertion 2

Impaction 2

Tensioning and Locking the Cable 2

Surgical Technique for Cable-Ready Long GTR Plate

Cable Insertion 3

Impaction 3

Tensioning and Locking the Cable 4

Surgical Technique for Cable-Ready Extended GTR Plate

Cable Insertion 5

Impaction 5

Fracture Reduction 5

Tensioning and Locking the Cable 6

Instruments and Implants 7

2Cable-Ready Greater Trochanteric Reattachment Surgical Technique

Short Integral Crimp GTR

Surgical Technique

Cable Insertion

Individual cables may be inserted

into the GTR before or after the GTR is

attached to the bone. However, the

cables must be inserted into the GTR

prior to passing the cable around the

femur. Two cables are included with

the GTR device. Should the most distal

cable be necessary, it is not packaged

with the device but is available

separately (item #00-2232-004-18).

In the usual lateral approach to

the femur, insert the cable into the

posterior side of the GTR (transverse

hole without the set screw), and pull

until the plug countersinks into the

plate. Pass the large Cable Passer

around the proximal femur from

posterior to anterior. Insert the free end

of the cable into the tip of the Cable

Passer until the cable is seen exiting

from the shaft of the Cable Passer (Fig.

1). Withdraw the Cable Passer, leaving

the cable around the bone. Insert the

cable through the transverse hole with

the Cable Passer.

Note: Cables can be passed from

medial to lateral or lateral to medial

depending on surgeon preference.

Place the first cable just distal to the

lesser trochanter, and the second

cable distal to the first cable. Do not

place the cable directly around the

prosthesis.

Impaction

Screw the Impact Driver into the

GTR. Impact the GTR onto the greater

trochanter. The upper hooks should

engage and wrap around the superior

portion of the trochanter (Fig. 2).

Tensioning and Locking the

Cable

It is recommended to use a cable at

each transverse pair of holes. Whether

or not a cable is utilized at a particular

location in the GTR, all set screws

must be seated at completion of the

procedure.

To tension the cable, insert the Cable

Plate Tensioner Bit (#00-2232-009-00)

into the tensioner. Thread the cable

completely through the tensioner

and pull the slack out of the cable.

Depress the lever at the back end of the

tensioner to lock the cable. To remove

any remaining slack in the cable,

depress the button on the tensioner

and pull out the excess slack. Rotate

the handle of the tensioner clockwise

until the desired tension is achieved

(Fig. 3).

Fig. 2

Impact Driver

Fig. 3

Cable Plate

Tensioner Bit

Tensioner

Fig. 1

Cable Passer

The following tensioning sequence

is recommended. Tension the cables

in proximal to distal direction, using

the tensioner bits to hold the tension.

Note: If a third cable is desired when

using the Short GTR, an externally

crimped cerclage cable (#00-2232-004-

18) can be passed through the distal

hole, and tensioned using the Cerclage

Attachment Bit (#00-2232-008-00).

Start proximally and work distally,

tensioning each cable and locking by

screwing in the appropriate set screw

in the GTR.

If an osteotomy was performed, use

the Impact Driver as a guide and

advance the greater trochanter onto a

good bed of bleeding bone.

Note: The most common reason for

nonunion of the greater trochanter

is poor or inadequate bone contact

between the greater trochanter and

proximal femur.

3

Cable-Ready Greater Trochanteric Reattachment Surgical Technique

Fig. 4

Hex Screwdriver

Fig. 5

Note: Whether or not all cable

locations are utilized, all set screws

should be locked down at the

completion of the procedure.

After each set screw is firmly seated

(Fig. 4), the tensioner and bits are

removed and the excess cable is cut off

flush with the GTR (Fig. 5).

Fig. 7

Plug Countersinks

into plate

Long Integral Crimp GTR

Surgical Technique

Cable Insertion

Individual cables may be inserted

into the GTR before or after the GTR is

attached to the bone (Fig. 6). However,

the cables must be inserted into the

GTR prior to passing the cable around

the femur.

In the usual lateral approach to

the femur, insert the cable into the

posterior side of the GTR (transverse

hole without the set screw), and pull

until the plug countersinks into the

plate (Fig. 7).

Fig. 6

Cable Passer

Pass the large Cable Passer around

the proximal femur from posterior to

anterior. Insert the free end of the

cable into the tip of the Cable Passer

until the cable is seen exiting from the

shaft of the Cable Passer. Withdraw the

Cable Passer, leaving the cable around

the bone. Insert the cable through the

transverse hole with the set screw.

Note: Cables can be passed from

medial to lateral or lateral to medial

depending on surgeon preference.

Place the first cable just distal to the

lesser trochanter, and the second

cable distal to the first cable. Do not

place the cable directly around the

prosthesis.

Impaction

Screw the Impact Driver into the

GTR. Impact the GTR onto the greater

trochanter. The upper hooks should

engage and wrap around the superior

portion of the trochanter (Fig. 8).

Fig. 8

4Cable-Ready Greater Trochanteric Reattachment Surgical Technique

If an osteotomy was performed, use the

Impact Driver as a guide and advance

the greater trochanter onto a good bed

of bleeding bone.

Note: The most common reason for

nonunion of the greater trochanter

is poor or inadequate bone contact

between the greater trochanter and

proximal femur.

Tensioning and Locking the

Cable

It is recommended to use a cable at

each transverse pair of holes. Whether

or not a cable is utilized at a particular

location in the GTR, all set screws

must be seated at completion of the

procedure.

To tension the cable, insert the Cable

Plate Tensioner Bit (#00-2232-009-00)

into the tensioner. Thread the cable

completely through the tensioner

and pull the slack out of the cable.

Depress the lever at the back end of the

tensioner to lock the cable. To remove

any remaining slack in the cable,

depress the button on the tensioner

and pull out the excess slack. Rotate

the handle of the tensioner clockwise

until the desired tension is achieved

(Fig. 9).

Fig. 9

The following tensioning sequence

is recommended. Tension the two

proximal cables first, using the

tensioner bits to hold the tension. The

distal cables in the plate section of the

Long GTR can then be tensioned, again

using the Bone Plate Tensioner Bits

to hold the tension (Fig. 10). The set

screws are not locked down at

this time.

Start proximally and work distally,

tensioning each cable and locking by

screwing in the appropriate set screw

in the GTR.

Note: Whether or not all cable

locations are utilized, all set screws

should be locked down at the

completion of the procedure.

After each set screw is firmly seated,

the tensioner and bits are removed and

the excess cable is cut off flush with the

GTR (Fig. 11).

Fig. 10

Hex Screwdriver

Fig. 11

Cable Cutters

5

Cable-Ready Greater Trochanteric Reattachment Surgical Technique

Cable Passer

Pass the large Cable Passer around

the proximal femur from posterior to

anterior. Insert the free end of the

cable into the tip of the Cable Passer

until the cable is seen exiting from the

shaft of the Cable Passer. Withdraw the

Cable Passer, leaving the cable around

the bone. Insert the cable through the

transverse hole with the set screw.

Note: Cables can be passed from

medial to lateral or lateral to medial

depending on surgeon preference.

Place the first cable just distal to the

lesser trochanter, and the second

cable distal to the first cable. Do not

place the cable directly around the

prosthesis.

Extended GTR Tech Tip #1 - the cables

may be harder to insert at the distal end

of the GTR if access is limited due to the

muscles, so it may be easier to insert

the distal cables into the GTR prior to

inserting the GTR.

Impaction

Screw the Impact Driver into the

GTR. Impact the GTR onto the greater

trochanter. The upper hooks should

engage and wrap around the superior

portion of the trochanter.

If an osteotomy was performed, use the

Impact Driver as a guide and advance

the greater trochanter onto a good bed

of bleeding bone.

Note: The most common reason for

nonunion of the greater trochanter

is poor or inadequate bone contact

between the greater trochanter and

proximal femur.

Fig. 12

Fig. 13

Fig. 14

Plug Countersinks

into plate

Fracture Reduction

The order of cable insertion depends

upon the fracture pattern, particular

use or situation. The cables can be

loosely tensioned by hand and held

with retensioning bits. The bone

fragments are then manipulated and

final reduction accomplished.

Extended GTR Tech Tip #2 - If cables are

inserted and pre-tensioned proximally

and on each end of the plate section

of the Extended GTR, the GTR and bone

can be grossly stabilized (Fig. 14). The

cables are very useful in holding the

reduction while cortical bone screws

are inserted.

Extended Integral Crimp

GTR Surgical Technique

Cable Insertion

Individual cables may be inserted

into the GTR before or after the GTR

is attached to the bone (Fig. 12).

However, the cables must be inserted

into the GTR prior to passing the cable

around the femur.

In the usual lateral approach to

the femur, insert the cable into the

posterior side of the GTR (transverse

hole without the set screw), and pull

until the plug countersinks into the

plate (Fig. 13).

6Cable-Ready Greater Trochanteric Reattachment Surgical Technique

Fig. 15

Fig. 16

Fig. 18

Tensioning and Locking the

Cable

It is recommended to use a cable at

each transverse pair of holes. Whether

or not a cable is utilized at a particular

location in the GTR, all set screws

must be seated at completion of the

procedure.

To tension the cable, insert the Cable

Plate Tensioner Bit (#00-2232-009-00)

into the tensioner. Thread the cable

completely through the tensioner and

pull the slack out of the cable (Fig. 15).

Extended GTR Tech Tip #3 - Once the

cables are pre-tensioned and the

fracture is reduced, cortical screws can

be inserted through the applicable

slots in the GTR (Fig. 16). Screws add

rotational stability, while cables add

bending strength to the construct.

Because cables do not provide

rotational stability, cortical screws

should always be used on both sides

(proximal and distal) of the fracture,

even if only unicortical screws are

used (4.5mm Trilogy® Acetabular

System Cortical Bone Screw Fixation

or NexGen® Complete Knee Solution

Osteotomy Screws are recommended).

Cables should not be locked down until

after screws are added, because the

addition of screws will fixate the GTR to

the bone and may loosen the tension in

the cables.

After screws have been added to the

GTR, the cables can be brought to final

tension. Start proximally and work

distally, tensioning each cable and

locking by screwing in the appropriate

set screw in the GTR (Fig. 17).

Note: Whether or not all cable

locations are utilized, all set screws

should be locked down at the

completion of the procedure.

After each set screw is firmly seated,

the tensioner and bits are removed and

the excess cable is cut off flush with the

GTR (Fig. 18).

Depress the lever at the back end of the

tensioner to lock the cable. To remove

any remaining slack in the cable,

depress the button on the tensioner

and pull out the excess slack. Rotate

the handle of the tensioner clockwise

until the desired tension is achieved.

The following tensioning sequence

is recommended. Tension the two

proximal cables first, using the

tensioner bits to hold the tension. The

distal cables in the plate section of the

4-hole and 5-hole Extended GTRs can

then be tensioned, again using the

Cable Plate Tensioner Bits to hold the

tension. The set screws are not locked

down at this time.

Fig. 17

7

Cable-Ready Greater Trochanteric Reattachment Surgical Technique

Prod. No. Description Size

00-2232-002-04 Integral Short GTR w/2 Cables* 23 x 53mm

00-2232-002-05 Integral Long GTR w/4 Cables* 23 x 121mm

00-2232-002-06 Extended 4-hole GTR w/4 Cables* 23 x 232mm

00-2232-002-07 Extended 5-hole GTR w/4 Cables* 23 x 261mm

*Cable included is 00-2232-005-18

00-2232-004-18

Cable Assembly w/Cerclage Crimp, Cobalt-Chrome

1.8 x 635mm

00-2232-005-18 Cable for GTR Device, Cobalt-Chrome 1.8 x 635mm

Greater Trochanter Reattachment Device

Instruments and Implants

Bone Screws

Prod. No. Description

00-6250-045-XX Trilogy Acetabular 4.5mm Cortical Bone Screws

00-5250-045-XX NexGen Osteotomy 4.5mm Cortical Bone Screws

Cable Instrumentation

Prod. No. Description

00-2232-000-01 Cable Instrumentation Set w/Case includes:

00-2232-005-00 Cable Tensioner for 1.8mm Cable

00-2232-006-00 Hex Head Screwdriver, 3.0mm

00-2232-007-20 Cable Passer, Medium

00-2232-007-30 Cable Passer, Large

00-2232-008-01 Cable Tensioner Bit

00-2232-009-00 Cable Plate Tensioner Bit

00-2232-011-00 GTR Impact Driver

00-3925-011-00 Cable Cutter

00-2232-095-00 Cable Instrument Case

Contact your Zimmer representative or visit us at www.zimmer.com

97-2232-107-00 Rev. 3 1004-T33 1ML ©2001, 2008, 2010 Zimmer, Inc.

Please refer to package insert for

complete product information, including

conrtaindications, warnings, precautions

and adverse effects

+H124972232011001/$100629R3G10M

The CE mark is valid only if it is also printed on the product label.

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