Gamma3 Long Nail R2.0 Operative Technique - Stryker

Gamma3 Long Nail R2.0 

Operative Technique 

Hip Fracture

Long Nail R .0 

Contributing Surgeons: 

Prof. Kwok Sui Leung, M. D. 

Chairman of Department of Orthopaedics and Traumatology 

The Chinese University of Hong Kong 

Prince of Wales Hospital 

Hong Kong 

Dr. Gilbert Taglang 

Head of the Trauma Department 

Center for Traumatology, Strasbourg 

France 

Prof. Dr. med. Volker Bühren 

Chief of Surgical Services 

Medical Director of Murnau Trauma Center, Murnau 

Germany 

Katsumi Sato M.D.Ph.D. 

Vice-Director, Chief Surgeon 

Tohoku University Graduate School of Medicine 

Tohoku Rosai Hospital, Sendai 

Japan 

Christopher T. Born M.D. 

Professor of Orthopaedic Surgery 

Temple University 

Philadelphia, PA 

USA 

Robert Probe, M.D. 

Division of Orthopaedic Surgery 

Scott & White Memorial Hospital, Temple, Tx 

USA 

Prof. Dr. med. Vilmos Vécsei 

Chief of Traumatology Department 

University of Vienna, Vienna 

Austria 

This publication sets forth detailed 

recommended procedures for 

using Stryker Trauma devices and 

instruments. 

It offers guidance that you should 

heed, but, as with any such technical 

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. 

Note: 

All bone screws referenced in this 

material here are not approved for 

screw attachment or fixation to the 

posterior elements (pedicles) of the 

cervical, thoracic or lumbar spine.

Contents 

Introduction 

Design Features of the Gamma3 System 

Lag Screw and Set Screw Function 

Distal Locking Screws 

Gamma3 System Benefits 

Indications/Contraindications 


Implant Selection 

Patient Positioning and Fracture Reduction 

Special Techniques for Fracture Reduction 

Incision 

Entry Point 

Preparation of Medullary Canal 

One Step Conical Reamer 

Cannulated Cutter 

Assembly of Targeting Device 

Nail Insertion and Positioning 

Lag Screw Positioning using One Shot Device 

Lag Screw Insertion 

Lag Screw Fixation 

Distal Screw Locking 

End Cap Insertion 

Nail Extension End Caps 

Postoperative Care and Rehabilitation 

Extraction of the Gamma3 Implant 

Dealing with Special Cases 

Ordering Information – Implants 

Ordering Information – Instruments 

Publications 

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51

Introduction 

Introduction 

The Gamma3 Locking Nail System is 

based on more than 16 years of Gamma 

Nail experience. This is the third 

generation of intramedullary short 

and long Gamma fixation nails. 

The Evolution of the successful Trochanteric 

and Long Gamma Nails as 

well as the Asia Pacific and Japanese 

versions followed strictly a step by 

step improvement based on the clinical 

experience of the clinical outcome 

from surgeons all over the world. 

The new Gamma3 System is designed 

to facilitate minimally invasive surgery 

and reduce the OR time down to 

a minimum by the aid of using new 

instrumentation and an optimized 

surgical technique. 

The nails have a proximal diameter of 

15.5mm to help minimize the incision 

length required for minimally invasive 

surgery. Nevertheless, they offer 

the same biomechanical strength and 

cut-out resistance as the well established 

Trochanteric and Long Gamma 

Nails. 

The new Lag Screw shape has been 

improved, especially in the area of the 

thread and the cutting flutes at the tip 

of the screw. The new design offers 

superior cutting behavior during Lag 

Screw insertion, providing extremely 

low insertion torque. The new thread 

design also offers excellent grip in the 

cancellous bone of the femoral head 

and strong resistance against cut-out. 

The 5mm distal locking screws are 

currently used in the Gamma-Ti and 

the T2 intramedullary nailing systems. 

A major advantage of the system is the 

newly designed instrument platform. 

The instruments are designed for a 

minimally invasive surgical technique 

and reduce OR time to a minimum. 

The instruments are easy to use and 

easy to clean, and they share the same 

platform as the Stryker intramedullary 

T2 and S2 nails. 

Acknowledgements: 

Our thanks are due to the many surgeons 

who supported the development 

of the new Gamma3 System, with their 

feedback and ideas, during worldwide 

panel meetings and helped the 

Gamma3 System to be what it is today. 

Special thanks to the Asian Pacific 

Technical Committee, who supported 

very early the idea of smaller implants 

for the treatment of proximal femur 

fractures.

Features 

Design Features of the Gamma3 

System 

Gamma3 Locking Nails come in 3 

neck-shaft angles of 120, 125 and 130°. 

• In the following, these Gamma3 

Nails are called: 

Long Nail 

All nails* use the same Lag Screws, Set 

Screw, distal Locking Screws and End 

Caps (see Fig. 1). 

Gamma3 Nail Long 

This nail incorporates several important 

mechanical design features. The 

nail is unslotted and cannulated for 

Guide-Wire-controlled insertion. To 

facilitate conformity with the human 

anatomy, the Long Nail is supplied in a 

left and right version. 

The three neck-shaft angles accommodate 

variations in femoral neck 

anatomy. The Long Nail offers the 

opportunity to use two distal Locking 

Screws that are inserted through the 

distal nail end to control rotation and 

telescoping. As shown below, the nail 

offers the possibility for either static, 

dynamic or secondary dynamic distal 

locking, depending on the fracture 

pattern. 

Long Nail Distal Locking Options 

* Each nail is supplied sterile packaged together with a Set Screw in one box. 

• Material: 

Titanium alloy with anodized type 

II surface treatment or Orthinox® 

High Strength Stainless Steel 

• Nail length: 

280mm to 460mm, in 20mm 

increments, shorter or longer nails 

are available on request 

• Nail diameter: 

proximal 15.5mm, distal: 11.0mm 

• Proximal Nail angle range: 

120°, 125°, 130° 

• M-L bend for valgus curvature: 

4 degrees 

• Proximal anterversion of 10° 

• End Caps 

0mm, +5mm and +10mm 

• Antecurvature radius R .0m of 

the shaft 

• Distal locking holes 

(round and oblong) 

for 5mm screws; up to 5mm 

dynamization is possible 

• Locking in the distal part of the oblong hole creates a dynamic locking 

mechanism − requires only one screw (see Fig. 2). 

• One screw placed in the distal part of the oblong hole and the other in the 

round hole. 

If dynamization is required after a period of time, the screw, placed in the 

round hole, has to be removed − requires two screws (see Fig. 3). 

• One screw placed in the round hole and the other is placed in the proximal 

part of the oblong hole − requires two screws (see Fig. 4). 

Fig. 2 

Dynamic Locking 

Fig. 3 

Secondary Dynamization 

Technical Specifications: 

Remove this screw to 

allow for dynamization 

Fig. 4 

Static Locking 


Gamma3 End Cap 

Gamma3 Set Screw 

120° 

125° 

130° 

Gamma3 Lag Screw 

Gamma3 Long Nail 

Fig. 1

Features 

Fig. 5 

Lag Screw Stabilization System 

Lag Screw and 

Set Screw Function 

The Lag Screws are designed to 

transfer the load of the femoral head 

into the nail shaft by bridging the 

fracture line to allow fast and secure 

fracture healing. The load carrying 

thread design of the Gamma3 Lag 

Screw provides large surface contact to 

the cancellous bone. This provides 

high resistance against cut out. 

Gamma3 Lag Screws feature a special 

tip profile to allow use with bone 

substitutes and the self-tapping thread 

is designed for easy insertion. 

The patented Set Screw is designed to 

fit into one of the four grooves of the 

shaft of the Lag Screw. This prevents 

both, rotation and medial migration 

of the Lag Screw. 

The nail allows sliding of the Lag 

Screw to the lateral side for dynamic 

bone compression at the fracture site 

to enhance fracture healing. 

Technical Specifications 

• Lag Screw diameter: 10.5mm 

• Lag Screw lengths: 70−120mm in 

5mm increments 

• Patented Lag Screw design for high 

load absorption and easy insertion 

• Asymmetrical depth profile to allow 

the Lag Screw to slide in the lateral 

direction only (see orange arrow on 

Fig. 5). 

• Patented self retaining Set Screw to 

secure the Lag Screw against 

rotation and simultaneously 

allowing sliding of the Lag Screw 

laterally.

Features 


The distal Locking Screw has a short 

self-tapping tip which facilitates a 

faster and easier start as well as easy 

screw insertion. It promotes excellent 

surface to bone contact (Fig. 6). 

Fig. 6 

The screw has an external diameter 

of 5mm, and provides an even higher 

fatigue strength than the clinically 

successful 6.28mm Locking Screw 

of the regular Gamma and G /K 

Locking Nail System (data on file). 

The screw diameter directly under the 

screw head has been reduced to 

prevent radial pressure that may cause 

micro fractures during screw insertion 

when the screw head reaches its final 

position. This reduction in diameter 

also improves the feel on the final 

tightening of the screw (Fig. 6a). 

Length Definition of 

the Distal Locking Screw 

The distal Locking Screw is measured 

from head to tip (Fig. 6b). 

Technical Specifications 

• Distal Locking Screw Diameter: 

5mm. 

• Distal Locking Screw lengths 

ranging from 25−50mm, in 2.5 and 

5mm increments. Longer screws up 

to 120mm are available on request. 

• Fully threaded screw design. 

Partially threaded screws are 

available on request 

• Self-tapping screw tip with 

optimized short cutting flutes. 

• Optimized diameter under the 

head helps to prevent microfractures 

during insertion. 

5mm 

Length Definition 

Reduced diameter 

Fig. 6a 

Fig. 6b

Features 

Gamma3 System Benefits 

Strength and Stability 

The biomechanical superiority of the 

intramedullary system offers significantly 

greater strength and stability 

compared with the side plate, in 

clinical use [1]. The new Gamma3 

system offers the same strength as the 

well established Gamma Locking Nail 

System. 

[1] K.S.Leung et al, Multicenter Trial 

of the Modified Gamma Nail in East 

Asia CORR323: 146−154,1996 

D 

D > d 

d 

The Biomechanical Advantage 

over Side-Plate Systems 

Since the load-bearing axis of the 

Gamma3 Nail is closer to the hip joint 

fulcrum, the effective lever arm on the 

implant and femur is significantly 

shorter than with an extramedullary 

plate. The reduction factor is equivalent 

to d/D as shown in Figure 7 (approximately 

25% [1]). 

The resultant force is transmitted 

directly down the femur using a nail 

system. If a side-plate system is used, 

the femur shaft may be weakened 

through a high amount of locking 

screws. The Gamma3 Nail increases 

both the strength and reliability of the 

bio-mechanical repair. The distal 

dynamic locking option additionally 

allows the use of dynamic 

compression. 

Fig. 7 

Rehabilitation Benefits 

The extra strength effectively gained 

through the biomechanics of the 

Gamma3 System combined with 

improved control of axial telescoping 

and rotational instability may allow 

earlier weight-bearing even in patients 

with complex or unstable proximal 

and combined ipsilateral shaft 

fractures. Early mobilization, dynamic 

compression, and a less traumatic 

operative technique increase the 

chance for rapid recovery and reliable 

bone union.


Indications /Contraindications 

Indications 

• Subtrochanteric fractures 

• Pertrochanteric fractures associated 

with shaft fractures 

• Pathological fractures (including 

prophylactic use) in both trochan- 

teric and diaphysal areas 

• Nonunion and malunion 

Contraindications 

Contraindications are medial neck 

fractures. 

Note: 

If no bone consolidation occurs the 

system may fail. The aim of postoperative 

care must be to ensure the 

promotion of bone consolidation. 

The aim of this operative technique 

manual is to provide the surgeon with 

a simple step-by-step operating guide 

to aid in successful addition of the 

Gamma3 System into their standard 

trauma care. Once the technique has 

been learned, the surgeon should find 

the operative procedure simple to 

implement. In fact, many of the basic 

principles for the Gamma3 System 

are those employed for all closed intramedullary 

nailing procedures. 

This operative technique has been 

devised in consultation with leading 

surgeons in many countries to be 

a basic guide, particularly for less 

experienced users of the Gamma3 

System. It is acknowledged that 

several alternative approaches to certain 

elements of the procedure are 

available, and may have advantages for 

particular situations or surgeons. 

Fig. 8


Fig. 9 

X-ray in a-p view, 

showing implant 

Implant Selection 

The Gamma3 Nail with a 125° nail 

angle may be used in the majority of 

patients. The 120° nail may be needed 

in patients with osteoarthritic coxa 

vara, and the 130° nail for coxa valga. 

Where such variations in femoral 

anatomy require an alternative, the 

following chapter describes how to 

select the optimal implant size. 

Preoperative Planning 

X-ray templates are very helpful 

during preoperative planning. Use the 

X-ray Templates (Fig. 9a) for short and 

long nails to select the correct implant 

and the optimal nail angle. 

These templates show the true implant 

size at a magnification of 15% in 

anterior-posterior view. The X-rays 

should be taken at this magnification 

(15%) for an optimum surgical 

outcome (see Fig. 9). If accurate anatomical 

reduction has been achieved, 

the X-ray can be taken from the fractured 

hip or from the contralateral 

side. 

Alternatively the femoral neck angle, 

i.e. the angle between the femoral 

shaft mid-axis and the femoral neck 

mid-axis, could be measured using a 

goniometer. The nail length may also 

be determinated intraoperatively using 

the Guide Wire Ruler together with 

the Guide Wire. 

10 

Fig. 9a 

Gamma3 Long Nail X-ray Template 

(Ref. No 1320-0005) 

Note: 

Please ensure precise alignment of 

the affected hip joint when using 

these templates. Template magnification 

is 15 %. All dimensions (nail 

angle and implant sizing) resulting 

from using these templates must be 

verified intraoperatively to ensure 

proper implant selection.


Patient Positioning and 

Fracture Reduction 

The procedure for patient positioning 

is usually similar to that of a subtrochanteric 

fracture, however, in fractures 

that are particularly difficult to 

reduce, a transcondylar sterile Steinmann 

pin may be used. The pin is 

fixed directly to the orthopaedic table 

by an adaptable stirrup, and traction is 

applied until anatomical reduction in 

the A-P view is obtained (Fig. 10). 

The patient is placed in a supine position 

on the fracture table and closed 

reduction of the fracture is recommended 

(Fig. 10a). 

Traction is applied to the fracture, 

keeping the leg straight. The upper 

trunk should be flexed to the opposite 

side so that the fracture can be 

reduced by not too much adduction of 

the lower limb. It also gives easy access 

to the greater trochanter. 

11 

Fig. 10 

Fig. 10a


1 

Fig. 11 

Fig. 11a 

Patient Positioning and 


Maintaining traction, the leg is internally 

rotated 10−15 degrees to complete 

fracture reduction; the patella 

should have either a horizontal or 

slightly inward position (Fig. 11). 

Position the image intensifier so that 

anterior-posterior and mediolateral 

views of the trochanteric region of the 

affected femur can be easily obtained. 

This position is best achieved if the 

image intensifier is positioned so that 

the axis of rotation of the intensifier is 

centered on the femoral neck of the affected 

femur (Fig. 11a). The views of 

the distal femur should also be easily 

obtained for distal locking. 

It is important to ensure that a view 

of both the distal and proximal tips 

of the nail can be obtained during the 

procedure without obstruction by the 

traction table. 

The patient is then prepared and 

draped as for standard femoral nailing 

procedures. When positioning the 

drapes, bear in mind that the incision 

will be more proximal. 

Note: 

Reduction should be achieved as anatomically as possible. If this is not 

achievable, reduction should be achieved at least in one plane. Reduction in the 

other plane may be achieved with the Gamma3 Long Nail during insertion.


Special Techniques for 


For specific situations, special 

techniques have been developed 

for fracture reduction, that are 

explained below. 

To counter this misalignment, the 

trunk is turned to the opposite side 

and held in position by a thoracic rest 

or by a large drape. This tightens the 

gluteus medius muscles and relaxes 

the psoas, externally rotating the 

proximal fragment into alignment 

and exposing the trochanter for easier 

introduction of the nail. The fractured 

limb is kept straight, with the knee in 

flexion (Fig. 12), using the stirrup to 

avoid adduction. This position helps 

to align the distal portion. Reduction 

is confirmed in the AP view. 

Subtrochanteric fractures cannot 

always be reduced during positioning 

in the lateral view, because the 

proximal fragment is drawn forward 

by tension from the psoas muscles. 

This may be reduced during surgery 

by using the Universal Rod (Fig. 12a). 

Care must be taken when introducing 

the implant as the proximal fragment 

may rotate during insertion. 

13 

Fig. 12 

Fig. 12a


1 

Fig. 13 

Fig. 14 

Fig. 15 

Fig. 16 

Incision 

Incisions may be developed in 

different manners. Two alternatives 

will be described below. 

Alternative 1: 

The tip of the greater trochanter may 

be located by palpation (Fig. 13) and 

a horizontal skin incision of approximately 

2−3cm is made from the 

greater trochanter in the direction 

of the iliac crest (Fig. 14). In obese 

patients the incision length may need 

to be longer, depending on obesity of 

the patient. 

A small incision is deepened through 

the fascia lata, splitting the abductor 

muscle approximately 1−2cm immediately 

above the tip of the greater trochanter, 

thus exposing its tip. A selfretaining 

retractor, or tissue protection 

sleeve is put in place. 

Alternative : 

A long and thin metal rod (e. g. Screw 

Scale, Long) is placed on the lateral side 

of the leg. Check with image intensifier, 

using l-m view, that the metal rod 

is positioned parallel to the bone in the 

center of the proximal part of the 

femoral canal (Fig. 16a). A line is drawn 

on the skin (Fig. 16). 

Fig. 16a


The C-arm is turned approx. 90° to 

provide an A-P image of the tip of 

the trochanter using the metal rod as 

shown in Fig. 17 and 17a. 

Fig. 17a 

A vertical line is drawn onto the skin 

(Fig. 18). The intersection of the lines 

indicates the position for the entry 

point of the nail. This is usually the 

anterior third of the tip of the greater 

trochanter as shown in Fig. 22. 

The skin incision is made cranially to 

the indicated intersection, following 

the sagital line in cranial direction. 

The distance between the intersection 

and the starting point for the incision 

differs, depending on the obesity of 

the patient. Under normal conditions 

it is a distance of approximately 2 cm. 

A small skin incision is made as 

described in Alternative 1 and shown 

in Fig. 20. 

1 

Fig. 17 

Fig. 18 

Fig. 19 

Fig. 20


anterior 1 /3 2 /3 posterior 

1 

Fig. 21 

Fig. 22 

Fig. 23 

Incision 

Using a finger, the tip of the trochanter 

should be felt easily (Fig. 21). 

Entry Point 

The correct entry point is located at 

the junction of the anterior third and 

posterior two-thirds of the tip of the 

greater trochanter and on the tip itself 

(Fig. 22). 

Preparation of the 

Medullary Canal 

In order to prepare the medullary 

canal for the Gamma3 Long Nail, 

3 possibilities are described in the next 

chapters. 


Opening the Cortex 

The medullary canal has to be opened 

under image intensification. The use 

of the cannulated Curved Awl (Fig. 23) 

is recommended if conventional 

reaming or the One Step Conical 

Reamer will be used to prepare the 

canal for the nail.


Reaming the Medullary Canal 

A 3mm ball-tipped Guide-Wire is 

recommended as a reamer guide. 

Pass the reamer Guide Wire through 

the cannulated curved awl into the 

shaft of the femur as shown, using the 

Guide Wire Handle (Fig. 24). 

Rotating the Guide Wire during insertion 

makes it easier to achieve the 

desired position in the middle of the 

medullary canal. 

Flexible reamers are used to ream the 

shaft of the femur in stages starting 

from 9mm diameter and increasing 

in 0.5mm increments (Fig. 25). The 

canal should be reamed at least 2mm 

larger than the distal diameter of the 

nail, 13mm for the Gamma3 Long 

Nail (Fig. 26). 

In order to accommodate the proximal 

part of the Gamma3 Long Nail, 

the subtrochanteric region must be 

opened up to 15.5mm (Fig. 27). This 

can be done either by reaming with 

the Stryker BIXCUT Reaming 

System (Fig. 25) or, alternatively, with 

the One Step Conical Reamer. For 

soft tissue protection, the Conical 

Reamer Sleeve should be used during 

reaming. 

Care must be taken with flexible 

reamers to ensure that the Guide- 

Wire is not displaced laterally during 

reaming. This could lead to resection 

of more bone on the lateral side, 

which in turn would lead to an offset 

position for the nail and a risk of 

shaft fracture. 

Note: 

Where the shaft is comminuted, 

reaming should be stopped at 

the fracture site and penetration 

continued with the power drill off. 

Bixcut Reamer 

The complete range of Bixcut 

reamers is available with either 

modular or fixed heads. 

13mm 

13mm 15,5mm 

1 

approx. 80mm 

Fig. 25 

Fig. 24 

Fig. 26 

Fig. 27


3mm Guide Wire 

or 3.2mm K-Wire One Step Conical Reamer 

K-Wire 

Multi Hole Trocar 

1 

Reamer Sleeve 

Fig. 28 

Fig. 29 

Alternative : 

One Step Conical Reamer 

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. 

Using Gamma3 Long Nails, it is 

recommended to ream the medullary 

canal all the way down to the condyle 

area, at least up to a diameter of 

13mm. 

After skin incision 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. 28 and 29). 

Entry Point Optimization 

The Entry Portal 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 

(Fig. 29) 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. 30 and 31) and 

prepare the canal for the proximal 

part of the Gamma3 Nail. The One 

Step Conical Reamer stops when the 

correct depth is reached. 

Note: 

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. 

If a 3.2mm K-Wire was used it 

should be replaced by a Guide Wire 

afterwards. 

1 

Fig. 30 

Fig. 31


0 

Fig. 32 


Cannulated Cutter 

Opening the cortex 

The Cannulated Cutter is a front 

cutting device used to prepare the 

proximal part of the femur for the 

Gamma3 Long Nail. 

It provides surgeons with an advanced 

option to open the proximal femur 

cavity without reaming. Especially in 

older patients it may reduce the 

requirement for reaming of the 

femoral cavity. For the Long Nail, it is 

recommended to ream the complete 

femur all the way down to the condyle 

area up to a diameter of at least 

13mm. 

The Cannulated Cutter is guided over 

a solid 4mm Guide Pin. The fixation 

of this Guide Pin in the bone allows 

for an optimal placement for the 

Cannulated Cutter. 

This device allows for easy collection 

of bone graft material which might be 

helpful in difficult healing conditions. 

Fig. 33


Assembly of Targeting Device 

1. Targeting Sleeve and 

Knob Assembly 

First assemble the Knob to the 

Targeting Sleeve (Fig. 34) and adjust 

the point on the Knob to be in line 

with the arrow on the Targeting 

Sleeve. Push the knob hard against 

the sleeve (Fig. 34a). The Knob moves 

approximately 5mm to the sleeve 

and has to be turned clockwise by 

approximately 30 degrees. Release the 

Knob and it will slip back the same 

distance. Now the Knob is assembled 

to the Targeting Sleeve and has to be 

connected to the Targeting Arm 

(Fig. 34b). 

. Targeting Arm and Targeting 

Sleeve Assembly 

Slide the Sleeve assembly over the 

Targeting Arm along the line until it 

stops (arrow line to arrow line). 

Rotate the Targeting Sleeve around to 

the required nail angle position for the 

Lag Screw, e. g. 125° (point to point) or 

distal locking positions, either 

“Dynamic” or “Static”. Now the 

Targeting Sleeve must be fixed in this 

position by pushing it strongly against 

the Targeting Arm. You will feel and 

hear, as the sleeve snaps into position. 

The Knobs only function is to lock the 

Lag Screw Guide Sleeve and the Tissue 

Protection Sleeve. 

Note: 

The Knob has to be assembled first 

to the Targeting Sleeve (Fig. 34a), 

otherwise the locking function of the 

sleeve may not work properly. 

Targeting Arm 

Targeting Sleeve 180 

green coded 

Knob 

Fig. 34 

1 

Fig. 34a Fig. 34b


Ball Tip Screwdriver 

Nail Holding Screw 

Targeting Arm 

Gamma3 Nail Long 

Fig. 35 

Gamma3 Long Nail Assembly 

3. Assembly of the Targeting 

Device and the Gamma3 Long Nail 

The selected Gamma3 Long Nail is 

now assembled to the Carbon Fibre 

Targeting Device as shown in Figure 

35. The nail connecting part of the 

Targeting Device is designed with an 

easy assembly function for fast and 

secure nail fixation. 

Ensure that the locating pegs fit into 

the corresponding notches of the 

proximal part of the nail. 

Fully tighten the Nail Holding Screw 

with the Ball Tip Screwdriver, so 

that it does not loosen during nail 

insertion. 

Before starting surgery the following 

two functions of the Targeting Device 

have to be checked: 

1. Secure fixation between Nail and 

Targeting Device 

2. Lag Screw Guide Sleeve matches 

the selected nail angle.


Before checking the function of the 

Lag Screw Guide Sleeve, the Knob 

must be positioned in the counter 

clockwise position. Pass the Lag Screw 

Guide Sleeve gently through the hole 

of the Targeting Sleeve and tighten it 

gently in its final position by turning 

the Knob clockwise. Check correct nail 

angle using the K-Wire, 4.2mm Drill 

or Lag Screw Step Drill (Fig. 36). 

Remove the Lag Screw Guide Sleeve by 

turning the Knob counter clockwise 

and pulling the sleeve back. 

Note: 

Before starting surgery, the implant 

and instrument assembly has 

to be checked. Ensure that the 

Targeting Sleeve angle matches the 

corresponding nail angle chosen, e. g. 

a 125° Targeting Sleeve for a 125° nail 

(Fig 36). 

Lag Screw Guide Sleeve 

3 

Fig. 36


Fig. 37 

Fig. 38 

Fig. 39 

Fig. 40 

Fig. 41 

Nail Insertion and Positioning 

Insert the Gamma3 Nail by hand 

(Fig. 37). 

DO NOT use undue force − 

NEVER use a hammer for 

nail insertion. 

The final nail depth is monitored with 

the image intensifier; the axis of the 

Lag Screw may be projected with a 

ruler on the monitor screen to ensure 

that the Lag Screw is placed in the 

optimal position. 

Proceed until the axis of the Lag 

Screw hole (visible as a crescent shape 

on the screen) is aligned with the 

lower half of the femoral neck (Fig. 

38). The objective of this is to ultimately 

position the Lag Screw slightly 

inferior in the femoral head in the 

frontal plane. 

Note: 

Make sure to remove the Guide Wire 

using the Guide Wire Handle (Fig. 39). 

When the Gamma3 Nail has been 

inserted to its final depth, check the 

anteversion of the nail. Use of the 

K-Wire Clip (Fig. 40) or the “One Shot 

Device” is recommended (see next 

page). 

Lag Screw Positioning 

using the K-Wire Clip 

The K-Wire Clip is mounted in the 

slots of the Targeting Arm by pressing 

the Clip flanges together. 

Using image intensification of the 

lateral view, the projection of the 

U-Wire on the bone shows the A-P 

positioning of the Lag Screw. 

The Lag Screw should be placed in 

the central position of the femoral 

head(Fig. 41). 

Before proceeding ensure that the Nail 

Holding Screw is still fully tightened.


Lag Screw Positioning using 

the One Shot Device 

The One Shot Device is 

recommended for optimal Lag 

Screw placement: 

The One Shot Device is recommended 

for verifying that the Lag 

Screw is placed in its optimal 

position. This device enables correct 

positioning of the K-Wire for Lag 

Screw placement before performing 

lateral skin incision and opening of 

the lateral cortex. Figures 42−43a 

give an overview of the working 

principle of the One Shot Device. 

nail positioned 

too caudal 

optimal nail position 

nail positioned 

too cranial 

Fig. 42a 

A/P view 

Positioning of nail depth 

Positioning of anteversion 

Fig. 42 

Fig. 43 

Fig. 43a 

Lateral view


Fig. 44 

Fig. 45 

Lag Screw Guide Sleeve in good contact to the lateral cortex 


The Targeting Device may be held 

by an assistant to prevent it from 

externally rotating the nail until the 

next stage is completed. 

Next, assemble the Lag Screw Guide 

Sleeve and the green coded 4.2mm 

Lag Screw Drill Guide Sleeve and pass 

them through the Targeting Sleeve 

to the level of the skin. At the point 

of contact, perform a small incision 

down to the bone (Fig. 44). The Guide 

Sleeve assembly is then advanced 

through the incision. If the sleeves 

catches the fascia lata, twisting it will 

usually allow it to pass through to the 

bone. 

In order to assure accurate Lag Screw 

length measurement, the outer 

Guide Sleeve must be in good contact 

to the lateral cortex of the femur 

(Fig. 45). The Knob of the Target 

Sleeve must be turned gently clockwise 

to lock the Guide Sleeve in place 

and further stabilize the targeting 

assembly.


With the Lag Screw Guide Sleeve 

firmly engaged in the cortex, the green 

coded 4.2mm Lag Screw Drill Guide 

Sleeve should be pushed gently against 

the cortex. Using the green coded 

4.2mm × 300mm center tipped drill, 

the lateral cortex should be opened by 

power tool or by hand (Fig. 46). 

The green coded 4.2mm Lag Screw 

Drill Guide Sleeve is then replaced by 

the K-Wire Sleeve. 

Both sleeves look similar but have 

different inner hole diameters. The K- 

Wire Sleeve has no colored ring. 

K-Wire Sleeve 

Lag Screw Drill Guide Sleeve 

Note: 

Before proceeding, check that the 

Guide Wire for the flexible reamer 

and nail insertion used earlier has 

been removed. 

The single use K-Wire inserted 

through the K-Wire Sleeve should 

be advanced up to the subchondral 

bone (Fig. 48), using the Guide Wire 

Handle. Check that the K-Wire is 

placed in the lower half of the femoral 

head in the frontal plane and on the 

midline in the lateral plane (Fig. 48). 

Check the position with the image 

intensifier in both the anteriorposterior 

and mediolateral views as 

shown in Figure 38 to ensure optimal 

K-Wire positioning. 

uSE K-WIRE FOR ONE 

SuRGICAL PROCEDuRE ONLy 

Fig. 46 

Opening of the lateral cortex 

Fig. 47 

K-Wire placement 


Fig. 49 

Lag Screw length measurement 

Fig. 50 

Lag Screw Length Measurement 


The objective is to position the Lag 

Screw below the center of the femoral 

head in the anterior-posterior view 

and centrally in the lateral view, to 

provide the best load transfer to the 

Lag Screw. 

After satisfactorily positioning the 

K-Wire, the required Lag Screw length 

is measured using the Lag Screw Ruler. 

Before starting to measure, ensure 

that the Lag Screw Guide Sleeve is still 

pressed firmly against the lateral cortex 

of the femur (Fig. 49). 

Place the Lag Screw Ruler directly 

under the K-Wire (Fig. 50). 

The recommended value for the Step 

Drill depth and the Lag Screw length 

can be read directly off the Lag Screw 

Ruler. If the value is between markings 

on the scale, e. g. 97mm, it should 

always be rounded up to the next 

higher value, e. g. 100mm. 

Note: 

K-Wires are not intended for re-use. 

They are single use only. K-Wires may 

be damaged or bent during surgical 

procedures. If a K-Wire is re-used, it 

may get lodged in the drill and could 

be advanced into the pelvis during 

the following steps of the procedure. 

This may damage large blood vessels 

or cause other serious injuries.


The value of the measurement (Fig. 

50) is now transferred to the adjustable 

stop on the Lag Screw Step Drill. 

The value e. g. 100 must be visible in 

the window of the Step Drill Stop (Fig. 

51). 

The K-Wire Sleeve is now removed 

and the adjusted Lag Screw Step Drill 

is passed over the K-Wire (Fig. 51a), 

through the Lag Screw Guide Sleeve. 

The channel for the Lag Screw is 

prepared using the T-handle 

connected to the Lag Screw Step Drill. 

If exceptional resistance is encountered, 

a power drill may be used with 

great care. 

Drilling should continue until the stop 

of the Step Drill comes into contact 

with the Lag Screw Guide Sleeve (Fig. 

51a). Ensure that the Targeting Device 

is well supported to prevent it from 

slipping back or rotating. 

The drilling process, especially 

when the tip of the drill comes close 

to its final position in the femoral 

head, should be controlled under an 

image intensifier to avoid hip joint 

penetration. The K-Wire can also be 

observed in the K-Wire window of the 

Step Drill. 

Note: 

It is important to observe the K-Wire 

tip during drilling on the intensifier. 

The K-Wire window provides an 

additional possibility to double check 

the K-Wire end position. Ensure that 

under no circumstances the K-Wire is 

advanced into the pelvis. 

K-Wire end 

Lock 

K-Wire window 

Fig. 51 

Window of the Step Drill Stop 

K-Wire window 

Fig. 51a 

Lag Screw 

Guide Sleeve 

Lag Screw Step 

Drill Stop 

Groove indicates 

K-Wire end position


30 

Fig. 52 

Fig. 53 

Lag Screw and Lag Screwdriver assembly 


During drilling, monitor the depth of 

the drill near the subchondral bone 

on image intensification. At this stage, 

you should see the tip of the K-Wire 

protruding about 6 to 10mm out of the 

step drill (Fig. 52) because the threaded 

portion of the K-Wire was intentionally 

not included in the drill measurement. 

This is to prevent the drill from 

penetrating the joint and to ensure 

that the K-Wire remains anchored in 

the subchondral bone after reaming. 

Remove the Step Drill by turning it 

clockwise and pulling it backwards. 

The length of the Lag Screw chosen 

should be the same as that of the Step 

Drill (in this example 100mm). The 

screw is then assembled to the Lag 

Screwdriver (Fig. 53). 

In a case where compression is to 

be applied, a shorter Lag Screw 

length should be chosen to avoid 

the Lag Screw sticking out too far 

out of the lateral cortex (see chapter 

Compression / Apposition below). 

Ensure that the pegs of the Lag 

Screwdriver are in the notches of the 

Lag Screw. The thumbwheel of the 

handle must be turned clockwise and 

finally tightened using the Ball Tip 

Screwdriver. 

The Lag Screw assembly is now passed 

over the K-Wire, through the Lag 

Screw Guide Sleeve and threaded up to 

the end of the predrilled hole into the 

femur head. Check the end position of 

the Lag Screw on the image intensifier. 

A double check of the end position is 

also possible with the indicator ring on 

the Lag Screw Screwdriver. The final 

position is obtained when the indicator 

ring reaches the end of the Lag Screw 

Guide Sleeve.



The handle of the Lag Screwdriver 

must be either parallel or perpendicular 

(90°) to the Targeting Arm (Fig. 

55 on next page) to ensure that the Set 

Screw is able to fit into one of the four 

grooves of the Lag Screw shaft. 

The Set Screw alignment indicator 

will help to find the right position of 

the handle. 

If the T-handle is not perpendicular or 

parallel to the Targeting Arm, turn it 

clockwise until it reaches this position. 

NEVER TURN THE LAG SCREW 

COUNTER CLOCKWISE. 

If the K-Wire is inadvertently removed, 

the screw may still be inserted without 

it, provided that the Guide Sleeve is still 

in contact with the cortex. 

Note: 

It is strongly recommended to place 

the Lag Screw at the end of predrilled 

hole in order to provide maximal 

resistance against cut out. Never turn 

the Lag Screw counter clockwise after 

the final position is reached because 

otherwise the Lag Screw may lose full 

bony surface contact to its tip. 

Compression / Apposition 

If compression or apposition of the 

fracture gap is required, this can be 

achieved by gently turning the thumbwheel 

of the Lag Screwdriver clockwise 

against the Guide Sleeve (Fig. 54). 

Before starting compression, make 

sure that the Lag Screw Guide Sleeve is 

unlocked to allow its free sliding. To 

unlock the Lag Screw Guide Sleeve, the 

Knob of the Target Device has to be 

turned counter clock-wise. In 

osteoporotic bone care must be taken 

to prevent Lag Screw pullout in the 

femoral head. The Lag Screw should be 

chosen shorter depending on the 

expected amount of compression. 

31 

Fig. 54 

Compression / Apposition turning the thumbwheel clockwise.


Set Screw Alignment Indicator 

3 

Fig. 56 

Set Screw insertion 

Fig. 55 

T-handle end position 


Note: 

The Set Screw must be used. 

The use of the Set Screw is not an 

option. 

Assemble the Set Screw to the Set 

Screw Driver. Insert the Set Screw 

as shown in Figure 56 along the 

opening of the post of the Targeting 

Device and advance it through the 

Nail Holding Screw. 

Push the Set Screw Driver down 

until you are sure, that the Set Screw 

engages the corresponding thread 

in the nail. During pushing down 

the assembly, you may feel a slight 

resistance. 

Turn the Screwdriver handle 

clockwise under continoues pressure. 

You may notice a slight resistance 

when turning the Set Screw. This is 

because the Set Screw thread is 

equipped with the “Nylstop” system 

to prevent spontaneous loosening. 

This is not the final position for the 

Set Screw. 

Keep on turning the Set Screw until 

you feel contact in one of the grooves 

of the Lag Screw.


To verify the engagement the Set 

Screw in a groove of the Lag Screw, 

try to turn the Lag Screwdriver gently 

clockwise and counter-clockwise. 

If it is not possible to turn the Lag 

Screwdriver the Set Screw is engaged 

in one of the grooves. If the Lag Screw 

Driver still moves, recorrect the 

T-handle position and tighten the Set 

Screw again until it engages in one of 

the four Lag Screw grooves. 

After slightly tightening the Set Screw, 

it should then be unscrewed by one 

quarter (¼) of a turn, until a small 

play can be felt at the Lag Screwdriver. 

This ensures a free sliding of the Lag 

Screw. 

Make sure that the Set Screw is still 

engaged in the groove by checking that 

it is still not possible to turn the Lag 

Screw with the Lag Screwdriver. 

Note: 

Do not unscrew the Set Screw more 

than ¼ of a turn. 

If distal locking is not indicated, the 

End Cap should be assembled to the 

nail end to prevent bone ingrowth. 

Leaving the Lag Screwdriver in 

place, the Nail Holding Screw is 

now removed using the Ball Tip 

Screwdriver, Universal Socket Wrench 

or Spreading Screwdriver and turning 

it counter clockwise. Insert the End 

Cap (size 0) using the Socket Wrench, 

Spreading Screwdriver or the Ball Tip 

Screwdriver. The End Cap should be 

tightened slightly. 

Please see “End Cap Insertion” chapter. 

Alternatively the End Cap could also 

be inserted free hand after removal of 

the Target Device. 

33 

Fig. 57


Fig. 58a 

Dynamic Locking 

Fig. 58b 

Secondary Dynamization 

Not in line with the Nail holes 

This is the best position to drill 

Not in line with the Nail holes 

This is the best position to drill; it shows correct view 

to be in line with the Nail holes 

3 

Fig. 58c 

Static Locking 

Fig. 58 

Fig. 59 

Fig. 60 

Distal Screw Locking 

Gamma3 Long Nails offer the 

possibility to be locked distally. For 

distal locking, the Long Nail offers the 

following three locking options (Fig. 

58), depending on the fracture pattern. 

Long Nail Distal Locking Options 

• Locking in the distal part of the 

oblong hole creates a dynamic 

locking mechanism − requires only 

one screw (see Fig. 58a). 

• One screw placed in the distal part 

of the oblong hole and the other in 

the round hole. 

If dynamization is required after a 

period of time, the screw, placed in 

the round hole, has to be removed − 

requires two screws (see Fig. 58b). 

• One screw placed in the round 

hole and the other is placed in the 

proximal part of the oblong hole − 

requires two screws (see Fig. 58c). 

Distal locking is recommended: 

• if the fracture is unstable 

• if rotational stability is required 

• if there is a wide disparity between 

the diameter of the nail and the 

femoral cavity. 

Various techniques can be used to 

guide drilling and insertion of screws 

through the distal holes. The freehand 

technique is described below. 

Visualizing the distal holes 

The essential initial step in distal 

targeting is to position the image 

intensifier so that the distal hole in 

the nail appears perfectly round. 

Naturally, this visualization steps 

refer to the appearance of the round 

and not the oblong hole. If the hole 

appears to be elliptical in either the 

vertical or horizontal plane, the image 

intensifier position must be adjusted 

appropriately as shown in Figures 59 

and 60. 

It is advised to correct image in one 

plane at a time.


Free-hand Technique 

The free-hand drill technique is used 

to fix the distal bone fragment to the 

nail using Locking Screws. Length and 

rotational alignment of the leg must 

be checked before locking the nail. 

The distal nail locking is described 

as follows, using the Static Locking 

mode according to Figures 61−63. Skin 

incisions are made in line with the 

distal holes of the nail. 

Once the image intensifier is correctly 

positioned as shown in Figures 

59 and 60, use the centre tipped 

Ø4.2mm×180mm, green coded drill 

and place the tip of the drill at an 

oblique angle to the centre of the hole 

(Fig. 61). Verify the position by X-ray 

and move the drill into the same plane 

as the holes in the nail, then drill 

through the first cortex and the nail 

until resistance of the second cortex is 

felt as shown in Figure 62. 

Alternatively, the drill can be drilled 

through the second cortex while 

viewing the image intensifier. The 

screw length can then be read directly 

from the Screw Scale on the drill 

(Fig. 64). 

If the Tissue Protection Sleeve is used 

with the drill, it has to be removed for 

the measurement. 

It is also possible to measure the 

correct screw length using the Free 

Hand Screw Gauge. After drilling 

through the second cortex, remove the 

drill and advance the small hook of the 

Screw Gauge through the holes behind 

the medial cortex and read out the 

required locking screw length. 

Insert the 5mm distal Locking Screw 

through the skin by using the 3.5mm 

Screwdriver; advance the screw head 

carefully until it is just in direct 

contact with the cortex (Fig. 65). 

Note: 

Take care not to overtighten. 

The screw head should just come 

into contact with the cortex and 

resistance should be felt. 

Fig. 62 

add thickness of the cortex 

(approx +5mm) to the read out value 

3 

anterior 

posterior 

Fig. 61 

Fig. 63 

direct read out 

Fig. 64 

Fig. 65


3 

Fig. 66 

Fig. 67 

Alternative 

Alternatively Condyle Screws could 

be used for distal locking. If a 

Condyle Screw will be inserted, both 

cortices are drilled to a diameter of 

5mm using the Ø5×230mm Drill in 

a free-hand drill technique. 

After drilling through the second 

cortex, remove the drill and advance 

the small hook of the Screw Gauge 

through the holes behind the medial 

cortex and read out the required 

condyle screw length (see Fig. 66). 

Note: 

The measurement equals Condyle 

Screw fixation length (from top of 

the Condyle Screw head to the top 

of Condyle Nut head, as shown in 

Fig. 66). The Condyle Screw length 

is defined with the Condyle Screw 

tip flush to the Condyle Nut head. 

The possible fixation length can 

be 2mm longer than the Condyle 

Screw length or 5mm shorter. 

Please ensure that the Condyle Nut 

is tightened a minimum of 5 turns 

on the Condyle Screw! 

Examples: 

Measurement Condyle Screw Length 

(mm) (mm) 

56 55 

57 55 or 60 

58 60 

59 60 

The Condyle Screw K-Wire 

Ø1.8×310mm inserted from the 

lateral side to the medial side. At the 

medial point of the perforation, a 

skin incision is made for the Condyle 

Screw. From the medial side, the 

Condyle Screw is now brought 

forward over the Condyle Screw K- 

Wire and inserted using the Condyle 

Screw Screwdriver. 

Insert the Condyle Nut over the K- 

Wire using the other Condyle Screw 

Screwdriver (Fig. 67). 

Alternatively, if patient anatomy 

allows, the Condyle Screw may be 

introduced from lateral to medial in a 

similar manner as described above.


Using both Condyle Screw 

Screwdrivers, the Condyle Nut and the 

Condyle Screw are tightened. Once 

tightened, the K-Wire is removed. 

The adjustable screw washers of the 

Condyle Screw and the Condyle 

Nut adapt to the surface of the bone. 

3 

Fig. 68


3 

Fig. 69 

End Cap assembly 

Fig. 70 

Final Nail assembly 

End Cap Insertion 

It is recommended to use an End Cap 

to close the proximal part of the nail to 

prevent bone ingrowth. 

Remove the Nail Holding Screw using 

the Ball Tip Screwdriver, Spreading 

Screwdriver, Universal Socket Wrench 

or Strike Plate. Load the End Cap (size 

0) to one of the Screwdrivers and pass 

the assembly through the top of the 

Targeting Device down into the nail. 

Turn the handle clockwise until 

it stops mechanically. Remove the 

Screwdriver and remove the Targeting 

Device in cranial direction. 

Alternatively the End Cap could also 

be inserted free hand after removal of 

the Targeting Device.


Nail Extension End Caps 

If the proximal end of the nail is 

completely sunk in the trochanter, 

End Caps in size +5mm and +10mm 

are available and can be assembled to 

the nail instead of the End Cap size 

0, to achieve cortical bone support 

proximally. The proximal part of 

the nail will be elongated by 5mm or 

10mm. 

These elongation End Caps are 

assembled using the Strike Plate with 

the self-retaining ring, the Spreading 

Screwdriver or Ball Tip Screwdriver. 

This can only be done if the Targeting 

Device is already removed from the 

nail. 

Postoperative Care 

and Rehabilitation 

Active and passive mobilization of the 

lower limbs may be started 

immediately. The injured limb should 

be kept elevated. 

For stable fractures that are locked 

statically or dynamically, full weight 

bearing walking may be started 

immediately. 

For unstable fractures with static 

locking, immediate full weight bearing 

walking is allowed in fractures with 

good bone contact. 

For fractures with poor bone contact 

due to comminution, partial weightbearing 

walking is allowed for the 

first 6 to 8 weeks. Full weight bearing 

walking can be commenced when 

there is a bridging callus formed as 

evident on the follow up X-ray. 

End Cap (size +10mm) 

End Cap (size +5mm) 

3 

Fig. 71


0 

Fig. 72 

Fig. 73 

Fig. 74 

Extraction of the 

Gamma3 Implant 

Where implant extraction is indicated, 

please proceed as follows: 

Step I (Fig. ) 

Remove the distal screw using the 

3.5mm Screwdriver after making an 

incision through the old scar. 

Step II (Fig. 3) 

Make a small incision through the 

old scar below the greater trochanter 

to expose the outer end of the Lag 

Screw. Remove any bony ingrowth 

which may be obstructing the outer 

end or internal thread of the Lag 

Screw as necessary to enable the Lag 

Screwdriver to engage fully. 

The K-Wire is then introduced via the 

Lag Screw into the head of the femur. 

The Lag Screwdriver is passed over the 

K-Wire, using the Lag Screw Guide 

Sleeve as a Tissue Protector, and 

engaged with the distal end of the 

Lag Screw. 

Check that ingrowth does not 

obstruct secure engagement of the 

Lag Screwdriver, otherwise the 

Lag Screw or Screwdriver may be 

damaged and extraction will be 

much more difficult. Tighten the 

thumbwheel clockwise. 

Step III (Fig. ) 

An incision is made over the proximal 

end of the nail, the proximal End Cap 

if used is removed using the Ball Tip 

Screwdriver, Spreading Screwdriver or 

Strike Plate, and the Set Screwdriver 

is engaged with the Set Screw. The Set 

Screw is rotated anti-clockwise until it 

is removed. 

Note: 

As the targeting device is not 

connected to the nail, we recommend 

using the Straight Set Screwdriver 

(1320-0210) for better guidance 

through the soft tissue to get access to 

the Set Screw.


Step IV (Fig. ) 

The Conical Extraction Rod is then 

threaded and tightened into the 

proximal end of the nail. The Lag 

Screw is extracted by anti clockwise 

rotation and pulling of the Lag Screwdriver. 

The K-Wire must then be 

removed. 

Note: 

It is useful to first turn the Lag Screw 

Screwdriver clockwise slightly to 

loosen possibly bony ingrowth in 

the screw threads before turning it 

counter clockwise. 

Step V (Fig. & ) 

An appropriate sliding hammer 

assembly is attached to the Extraction 

Rod and the nail extracted. 

1 

Fig. 75 

Fig. 76 

Fig. 77


Fig. 78 

Dealing with Special Cases 

Posterior Displacement 

In case of a comminuted fracture, 

there is a tendency of the fracture to 

become displaced posteriorly, making 

it difficult to place the K-Wire into the 

center of the neck and head. This can 

be solved by lifting the nail insertion 

Targeting Device (Fig. 78). 

Alternatively, an assistant can lift up 

the greater trochanter manually or 

with a reduction spoon; or support it 

with a sandbag. This will maintain the 

neck and the femur in almost the same 

axis, facilitating passage of the K-Wire 

through the center of the neck and 

head. 

The position should then be checked in 

both the anterior-posterior and lateral 

views using the image intensifier.


Packaging 

All implants are packed sterile only. 

The Nail and Lag Screw Implant have 

to be secured using the Set Screw 

in every surgical operation, without 

exception (see also page 33). 

The Nail and the Set Screw are 

therefore supplied together in the 

same blister pack (see Fig. 79). 

The blister is packed in a white 

carton and wrapped to protect the 

contents during transportation and 

storage. 

Only two package sizes are used for 

all the nails (Fig. 80). 

The long nails are packed in a longer 

box and the short nails in a shorter 

box. 

This facilitates identification in the 

storage area. 

The package carries also the date 

of sealing and a sterility expiration 

date. 

Long Nail, packaging example 

Trochanteric Nail, packaging example 

Gamma3 Set Screw 

Gamma3 Long Nail 

Fig. 80 Fig. 79 

3


Long Nail Kit R .0, Ti, Left*, Ø1 . /11mm 

Lag Screw, TI** 

Titanium Length Angle 

REF mm ° 

3320-0280S 280 120 

3320-0300S 300 120 

3320-0320S 320 120 

3320-0340S 340 120 

3320-0360S 360 120 

3320-0380S 380 120 

3320-0400S 400 120 

3320-0420S 420 120 

3320-0440S 440 120 

3320-0460S 460 120 

3325-0280S 280 125 

3325-0300S 300 125 

3325-0320S 320 125 

3325-0340S 340 125 

3325-0360S 360 125 

3325-0380S 380 125 

3325-0400S 400 125 

3325-0420S 420 125 

3325-0440S 440 125 

3325-0460S 460 125 

3330-0280S 280 130 

3330-0300S 300 130 

3330-0320S 320 130 

3330-0340S 340 130 

3330-0360S 360 130 

3330-0380S 380 130 

3330-0400S 400 130 

3330-0420S 420 130 

3330-0440S 440 130 

3330-0460S 460 130 

Titanium Diameter Length 

REF mm mm 

3060-0070S 10.5 70 

3060-0075S 10.5 75 

3060-0080S 10.5 80 

3060-0085S 10.5 85 

3060-0090S 10.5 90 

3060-0095S 10.5 95 

3060-0105S 10.5 100 

3060-0105S 10.5 105 

3060-0115S 10.5 110 

3060-0115S 10.5 115 

3060-0120S 10. 5 120 

Long Nail Kit R .0, Ti, Right*, Ø1 . /11mm 

Titanium Length Angle 

REF mm ° 

3220-0280S 280 120 

3220-0300S 300 120 

3220-0320S 320 120 

3220-0340S 340 120 

3220-0360S 360 120 

3220-0380S 380 120 

3220-0400S 400 120 

3220-0420S 420 120 

3220-0440S 440 120 

3220-0460S 460 120 

3225-0280S 280 125 

3225-0300S 300 125 

3225-0320S 320 125 

3225-0340S 340 125 

3225-0360S 360 125 

3225-0380S 380 125 

3225-0400S 400 125 

3225-0420S 420 125 

3225-0440S 440 125 

3225-0460S 460 125 

3230-0280S 280 130 

3230-0300S 300 130 

3230-0320S 320 130 

3230-0340S 340 130 

3230-0360S 360 130 

3230-0380S 380 130 

3230-0400S 400 130 

3230-0420S 420 130 

3230-0440S 440 130 

3230-0460S 460 130 

mm fully threaded Locking Screws, TI*** 


REF mm mm 

1896-5025S 5.0 25.0 

1896-5027S 5.0 27.5 

1896-5030S 5.0 30.0 

1896-5032S 5.0 32.5 

1896-5035S 5.0 35.0 

1896-5037S 5.0 37.5 

1896-5040S 5.0 40.0 

1896-5042S 5.0 42.5 

1896-5045S 5.0 45.0 

1896-5050S 5.0 50.0 

1896-5055S 5.0 55.0 

1896-5060S 5.0 60.0 

1896-5065S 5.0 65.0 

1896-5070S 5.0 70.0 

1896-5075S 5.0 75.0 

1896-5080S 5.0 80.0 

1896-5085S 5.0 85.0 

1896-5090S 5.0 90.0 

* Nails are packed together with the Set Screw, sterile 

** Longer Lag Screws are available on request. 

*** Longer Locking Screws as well as partly threaded screws are available on request.


Set Screws, TI (available separately) End Caps, TI 


REF mm mm 

3003-0822S 8.0 17.5 

Condyle Screws, TI Nut for Condyle Screw, TI 


REF mm mm 

1895-5040S 5.0 40 

1895-5045S 5.0 45 

1895-5050S 5.0 50 

1895-5055S 5.0 55 

1895-5060S 5.0 60 

1895-5065S 5.0 65 

1895-5070S 5.0 70 

1895-5075S 5.0 75 

1895-5080S 5.0 80 

1895-5085S 5.0 85 

1895-5090S 5.0 90 


REF mm mm 

3005-1100S 11.0 0 

3005-1105S 15.5 +5 

3005-1110S 15.5 10 


REF mm mm 

1895-5001S − 17.0


Long Nail Kit R .0, StSt, Left*, Ø1 . /11mm Long Nail Kit R .0, StSt, Right*, Ø1 . /11mm 

Lag Screw, StSt** 

Stainless Steel Length Angle 

REF mm ° 

4320-0280S 280 120 

4320-0300S 300 120 

4320-0320S 320 120 

4320-0340S 340 120 

4320-0360S 360 120 

4320-0380S 380 120 

4320-0400S 400 120 

4320-0420S 420 120 

4320-0440S 440 120 

4320-0460S 460 120 

4325-0280S 280 125 

4325-0300S 300 125 

4325-0320S 320 125 

4325-0340S 340 125 

4325-0360S 360 125 

4325-0380S 380 125 

4325-0400S 400 125 

4325-0420S 420 125 

4325-0440S 440 125 

4325-0460S 460 125 

4330-0280S 280 130 

4330-0300S 300 130 

4330-0320S 320 130 

4330-0340S 340 130 

4330-0360S 360 130 

4330-0380S 380 130 

4330-0400S 400 130 

4330-0420S 420 130 

4330-0440S 440 130 

4330-0460S 460 130 

Stainless Steel Diameter Length 

REF mm mm 

4060-0070S 10.5 70 

4060-0075S 10.5 75 

4060-0080S 10.5 80 

4060-0085S 10.5 85 

4060-0090S 10.5 90 

4060-0095S 10.5 95 

4060-0100S 10.5 100 

4060-0105S 10.5 105 

4060-0110S 10.5 110 

4060-0115S 10.5 115 

4060-0120S 10.5 120 

Stainless Steel Length Angle 

REF mm ° 

4220-0280S 280 120 

4220-0300S 300 120 

4220-0320S 320 120 

4220-0340S 340 120 

4220-0360S 360 120 

4220-0380S 380 120 

4220-0400S 400 120 

4220-0420S 420 120 

4220-0440S 440 120 

4220-0460S 460 120 

4225-0280S 280 125 

4225-0300S 300 125 

4225-0320S 320 125 

4225-0340S 340 125 

4225-0360S 360 125 

4225-0380S 380 125 

4225-0400S 400 125 

4225-0420S 420 125 

4225-0440S 440 125 

4225-0460S 460 125 

4230-0280S 280 130 

4230-0300S 300 130 

4230-0320S 320 130 

4230-0340S 340 130 

4230-0360S 360 130 

4230-0380S 380 130 

4230-0400S 400 130 

4230-0420S 420 130 

4230-0440S 440 130 

4230-0460S 460 130 

mm fully threaded Locking Screws, StSt*** 


REF mm mm 

1796-5025S 5.0 25.0 

1796-5027S 5.0 27.5 

1796-5030S 5.0 30.0 

1796-5032S 5.0 32.5 

1796-5035S 5.0 35.0 

1796-5037S 5.0 37.5 

1796-5040S 5.0 40.0 

1796-5042S 5.0 42.5 

1796-5045S 5.0 45.0 

1796-5050S 5.0 50.0 

1796-5055S 5.0 55.0 

1796-5060S 5.0 60.0 

1796-5065S 5.0 65.0 

1796-5070S 5.0 70.0 

1796-5075S 5.0 75.0 

1796-5080S 5.0 80.0 

1796-5085S 5.0 85.0 

1796-5090S 5.0 90.0 

* Nails are packed together with the Set Screw, sterile 

** Longer Lag Screws are available on request. 

*** Longer Locking Screws as well as partly threaded screws are available on request.


Set Screw, StSt (available separately) End Caps, StSt 


REF mm mm 

4003-0822S 8.0 17.5 

Condyle Screws, StSt Nut for Condyle Screw, StSt 


REF mm mm 

1795-5040S 5.0 40 

1795-5045S 5.0 45 

1795-5050S 5.0 50 

1795-5055S 5.0 55 

1795-5060S 5.0 60 

1795-5065S 5.0 65 

1795-5070S 5.0 70 

1795-5075S 5.0 75 

1795-5080S 5.0 80 

1795-5085S 5.0 85 

1795-5090S 5.0 90 


REF mm mm 

4005-1100S 11.0 0 

4005-1105S 15.5 +5 

4005-1110S 15.5 10 


REF mm mm 

1795-5001S − 17.0


REF Description 

Basic Instruments 

702628 

1210-6450S 

1320-0065 

1320-0090 

1320-0100 

1320-0105 

1320-0110 

1320-0118 

1320-0130 

1320-0140 

1320-0150 

1320-0180 

1320-0190 

1320-0200 

1320-0231 

1320-3042S 

1806-0041 

1806-0095 

1806-0096 

1806-0185 

1320-0215 

1806-0232 

1320-0315 

1806-0325 

1806-0365 

1806-0480 

1320-3042 

1806-4270S 

1320-9000 

1320-6000 

T-Handle, Quicklock 

Kirschner wire, sterile 

Screwdriver 8mm, Ball-Tip, T-handle 

Nail Holding Screw 

Gamma3 Targeting Arm 

Knob for Targeting Sleeve 

Clip for K-Wire 

Targeting Sleeve 180, green coded 

Lag Screw Guide Sleeve 

Drill Guide Sleeve 4.2mm for Lag Screw, green 

K-Wire Sleeve 

Lag Screw Ruler 

Lag Screw Step Drill 

Lag Screw Driver 

Flexible Set Screwdriver, 4mm, small shaft (silicon covered) 

Drill Ø4,2 × 300mm, AO small, green, sterile 

Awl, Curved 

Guide Wire Handle 

Guide Wire Handle Chuck 

Tissue Protection Sleeve, Long 

Gamma3 Drill Sleeve 

Screwdriver, Long 

Gamma3 Trocar 

Screw Gauge, Long 

Screw Scale, Long (for Long Nail) 

Screw Gauge (for Long Nail) 

Drill Ø4,2 × 300mm, AO small, green, unsterile 

Drill Ø4,2 × 180mm, AO small, green, sterile (for Long Nail) 

Instrument Tray, Basic, empty 

Instrument Set, Basic, completly filled



Basic Instruments 

Not stored on the Tray 

1320-0131 

1806-0085S 

702634 

1320-0112 

1320-9002 

1806-0032 

1320-0210 

1320-3042 

1320-3045S 

Optional Instruments 

0152-0218 

1320-0041 

1320-0042 

1213-9091S 

1320-0011 

1320-0021 

1320-0026 

1320-0031 

1320-0066 

1320-0070 

1320-0080 

1320-0135 

1320-0160 

1320-0170 

1320-3030S 

1320-3045S 

Lag Screw Guide Sleeve, navigated 

Guide Wire, Ball Tip, Ø3 × 1000, Sterile 

Large AO Coupling Hall Fitting 

Gamma3 U-Wire 

Insert for Bixcut Reamer Heads for Diameter 11, 12, 13, 14, 15.5mm 

Trocar for Curved Awl, (Awl Plug) 

Straight Screwdriver, 4mm for Set Screw 

Drill 4.2 × 300mm, AO small, green, unsterile 

Drill 4.2 × 300mm, Tri-Flat Fitting, sterile 

K-Wire 1,8×310mm, for Condyle Screws 

Cannulated Cutter, use with 4mm Pin only 

Sleeve for Cannulated Cutter 

Guide Pin 4×400mm, sterile 

One Step Conical Reamer,working with Conical Reamer Sleeve short and long 

Conical Reamer Trocar, short 

Multihole Trocar, short 

Conical Reamer Sleeve, short 

Spreading Screwdriver 

Screwdriver Strike Plate 

Universal Joint Socket Wrench 

Adaptor for One Shot Device, Gamma 

Fragment Control Clip 

Fragment Control Sleeve 

Drill 3,0×300mm, AO small, sterile, white (for Fragment Control Clip) 

Drill 3.0×300mm, Tri-Flat Fitting, sterile, white (for Fragment Control Clip)


0 


Optional Instruments 

1320-3010 

1407-4006 

1806-0020 

1806-0110 

1806-0125 

1806-0130 

1806-0170 

1806-0255 

1806-0450 

1806-0460 

1806-4290S 

1806-5000S 

1320-0022 

1320-0027 

1320-0032 

1320-9002 

1320-0210 

1320-6010 

1320-9400 

1320-9005 

X-Ray Template 

1320-0002 

1320-0005 

One Shot Device, Gamma3 

Nail Extraction Adapter 

Guide Wire Ruler (for Long Nail) 

Universal Rod 

Reduction Spoon 

Wrench, 8mm / 10mm 

Slotted Hammer 

Condyle Screwdriver (for Condyle Screws) 

Tissue Protection Sleeve 

Drill Sleeve Ø4.2mm 

Drill 4,2×230mm, AO small, sterile, green (Long Nail) 

Drill, 5×230mm, AO small, sterile, black (for Condyle or Shaft Screws) 

Conical Reamer Trocar, long 

Multihole Trocar, long 

Conical Reamer Sleeve, long 

Insert for Bixcut Reamer Heads for Diameter 11, 12, 13, 14, 15.5mm 

Straight Screwdriver, 4mm for Set Screw 

Extraktion Set 

Extraktion Tray 

Instrument Tray, Optional 

X-Ray Template, Gamma3 Nail 180 

X-Ray Template, Gamma3 Long Nail, R 2.0

References 

Publications 

More than 1.000.000 Gamma Nail implantations have been performed 

world wide over the last 17 years. Extensive clinical experience has been 

published with the Gamma Locking Nail. 

We recommend the following publications: 

• The Gamma Locking Nail, Ten Years Surgical Experience 

Gahr, R. H.; Leung, K.-S.; Rosenwasser, M.P.; Roth, W. (eds.), 

Einhorn-Presse Verlag, ISBN 3-88756-808-7 

• Patients treated with the Long Gamma Nail, 

R. van Doorn, 

Bedrijfsnaam: Castellum Drukwerk Vof. 

These books contain almost 300 clinical reports available on request. 

1

Trauma, Extremities & Deformities 

Biologics 

Surgical Products 

Neuro & ENT 

The information presented in this brochure is intended to demonstrate a Stryker product. Always refer to the package 

insert, product label and/or user instructions before using any Stryker product. Surgeons must always rely on their own 

clinical judgment when deciding which products and techniques to use with their patients. Products may not be available 

in all markets. Product availability is subject to the regulatory or medical practices that govern individual markets. 

Please contact your Stryker representative if you have questions about the availability of Stryker products in your area. 

Stryker Corporation or its subsidiary owns the registered trademark: Stryker 

Stryker Corporation or its subsidiary owns, uses or has applied for the following trademarks: Gamma3 

Literature Number : B 0300009 

LOT D3207 

Copyright © 2007 Stryker 

Printed in Germany 

Trauma, Extremities & Deformities 

Biologics 

Surgical Products 

Neuro & ENT 

Stryker Trauma GmbH 

Prof.-Küntscher-Strasse 1–5 

D - 24232 Schönkirchen 

Germany 

www.osteosynthesis.stryker.com

Gamma3 Long Nail R2.0 Operative Technique - Stryker

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