DynaNail® TTC Fusion System– Surgical Technique Guide DynaNail® TTC Fusion System– Surgical Technique Gu | Page 19

9 A Implant Insertion Instruments Used: 1. Anvil Attachment (1) Remove the Bead Tipped Guidewire and insert the DynaNail into the medullary canal, rotating the Targeting Frame to help advance the Implant. If additional force is required to advance the Implant, slide the Anvil Attachment onto the Targeting Frame (A) and strike the Anvil with a mallet (B). The Anvil Attachment can be removed after the DynaNail Implant is inserted. TECH TIPS • Do NOT strike any other part of the frame besides the Anvil Attachment. • Hold at least one side of the anvil down in the slot to ensure that it does not slip out and fall. • Pay attention to rotation of Nail Implant during insertion. Too medial of an entry point combined with internal rotation may affect the position and purchase of the calcaneal PA screw. L-M Screw Hole aligned with subtalar joint Distal end of Nail subflush with calcaneus B Nail Placement Guidelines: Position the lateral-to-medial calcaneal screw hole as proximal as possible in the calcaneus (after the Compressive Element is stretched in the following step). In this proximal position, the lateral screw gains optimal purchase by targeting the longest possible screw in the widest part of the calcaneus. This proximal position also countersinks the DynaNail as far as possible within the calcaneus. Countersink the distal end of the DynaNail Implant 6 mm in the calcaneus (Refer to X-Ray). The Outer Body will translate distally up to 6 mm as the Compressive Element unloads post-operatively. TECH TIP • To achieve optimal lateral-to-medial screw positioning after the Compressive Element is stretched, insert the DynaNail Implant until the lateral-to-medial screw hole is aligned with the subtalar joint (refer to X-Ray). In this case when the Compressive Element is stretched to the maximum 6 mm (Step 10), this screw hole will translate distally by 6 mm, placing it in the optimal proximal position within the calcaneus. 19