Osteosynthesis

Gamma3 Virtual Surgery Description on how to Start and Run the Virtual Surgery Training Program

Dear Gamma3 Virtual Surgery User, Thank you for your interest into the Gamma3 Virtual Surgery. We are proud to announce the availability of the second module of the Gamma3 Virtual Surgery Training Program which takes care of the Distal Locking Procedure and Nail End Cap Insertion. It is based on the first module, the so called Gamma3 Virtual Surgery Lag Screw Positioning. The Virtual Surgery Training Program is a computer animated 3D real-time learning applications, which is intended to help understanding the use of the Gamma3 system and to improve your skills in distally locking the Gamma3 Trochanteric 180 Nail. Furthermore, it allows learning the difference between static and dynamic locking, the different procedures of Locking Screw measurement and End Cap setting. On the next pages you will find a short description on how to start this free application and to run this virtual training session. We have tested this application on many computers worldwide and it performed well so far without any issues. However, due to different computer types, firewall settings and software versions in different locations, there is a potential possibility that you may face difficulties with this program. In this case please contact your IT responsible person or your IT-Department with this document and ask for their support.

1. FREE DOWNLOAD / REGISTER / LOGIN at Stryker Osteosynthesis Web Site: The Gamma3 Virtual Surgery software is a small software package program and has to be downloaded to your hard drive first. Once the software is installed on your hard drive, you just need internet connection to open and run the Gamma3 Virtual Training. Make sure that you have internet connection (from your Office or through VPN) and your internet browser e.g. Microsoft Internet Explorer is opened. Then click (Ctrl+click) on the link below to enter Stryker Osteosynthesis Web Site for login and/or download procedure: http://www.osteosynthesis.stryker.com/webpages/gamma_virtual_surgery_dl/ After being connected to this link you should be now on the Gamma3 Virtual Surgery Login page for registered users. Please type in your Username and Password and you will have direct access to the Virtual Training Program. In case you have not been registered yet, please click on Register here Hyperlink for registration and your Username and Password will be send directly to your email account.

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Tip: In case the link does not work correctly, please copy the link and paste it into the URL line of your Internet Browser. Please be patient during download - The download can take some time depending on the speed of your internet connection and the computer performance. Follow the installation instructions on the screen. If you are asked for agreement of Adobe and 3dvia Virtools, please agree to their conditions in order to further proceed. Both support programs are freeware. Tip: According to your PC/Laptop or firewall settings, you may see yellow Pop Up Blockers in the upper part of your screen, please also allow them to go through by clicking with the right mouse button. If you encounter technical difficulties at this point, please contact your IT-Support. Your IT-Support should know this information: Your server/computer should authorize the *.vmo download (MIME TYPE: Application/octet-stream)

2. START the Gamma3 Virtual Surgery Program (Make sure you have internet connection) The Gamma3 Virtual Training Program can be started only, if the download process was successful. Once you have successfully downloaded the Program, you can start it by using the same link as before http://www.osteosynthesis.stryker.com/webpages/gamma_virtual_surgery_dl/ Tip: Book mark this link under your favorites to ease access

Please read the auto scrolling introduction text, when proceeding for the first time. You will find here important information, as e.g. Goal of the virtual training, virtual OR Environment, case situation of the patient. After having read this page click the green framed Start Program buttons in the right lower corner (red circle) in order to get to the next page of introduction.

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Quick Step Introduction of the virtual OR as well as functions of the buttons This Quick Step Introduction page provides an overview of the virtual OR Environment as well as the different functions and possibilities you may work with during the training session. All buttons have a mouse over as well as a short description of their functions (no real executions at this stage). Detailed information of each function will be explained in later chapters.

Having understood the above first Quick Step Introduction page (above), click the green framed Click HERE button in the right lower corner (red circle) and you will be forwarded to the second Quick Step Introduction page. Note: DO NOT USE THE BACK-BUTTON of your Internet Explorer. The Virtual Surgery Program does not support back-button functionality. Using it would bring you back to the introduction page of the program. This page is explaining how to use/navigate the keyboard and/or the computer mouse.

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You are one step away now from entering the virtual operating room. By clicking the green framed START TRAINING button (red circle) you will finally be directed into the virtual OR.

Entering the virtual Operating Room Click into the light blue field (no cursor is blinking) and type your name or nick name into it. This is not a mandatory step. Your name will not be saved in any database. It only appears at the end of the virtual surgery together with your training results.

Please continue now by pressing the ENTER button on your keyboard in order to enter the operating room.

You will find the following conditions in the operating room: The Patient is positioned on a radiolucent fracture table The trochanteric Hip Fracture has been reduced anatomically The Gamma3 Trochanteric Nail including the Lag Screw and Set Screw have already been implanted.

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Starting your virtual training session: As mentioned already in the introduction section, this virtual training module focuses on the Distal Locking and End Cap Insertion only, therefore previous surgical steps like trochanteric fracture reduction, Implantation of the Gamma3 Trochanteric Nail, Lag Screw Positioning and Set Screw Setting have already been made.

When ever you need a virtual X-Ray image, press your keyboard X button

Command Line:
Always follow the hints on this line

Help button for Keybord/Mouse

usage

Confirm each step by clicking OK. The next steps of the surgery starts semi-automatically or the Instrument Tool Bar appears to click the next instruments

Allows to enlarge /minimize the size of the X-Ray monitor (see picture below)

First Step: Press your X Keybord Button and check your X-Ray on the monitor view as shown above

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Next Steps: Click the right instrument from the toolbox, Choose an instrument from the Tool Bar with a simple mouse click. You will get an error message, in case you will choose the wrong instrument. The correctly choosen instrument will appear in the the operating field. Always follow the instructions on the upper right Command Line to perform your next step

and always complete with the OK Button, when adjustment is finished, in order to proceed further on.

Semi-automatic procedures have been included, so that you do not have to make all steps on your own. When the semi-automatic step has been completed, please follow the instructions on the above Command Line.

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Your Virtual Training Results: After completing the virtual surgery (this is directly after inserting the End Cap), the measured results will appear in a table as shown below. The numbers of X-Rays you have taken through the procedure have been summed up.

Number of X-Rays There can also show up an error message Click for additional product information See the final 3D view

By Clicking on Click here to get more information on the Distal Locking procedure the program will provide you with some very helpful Tips for the Distal Locking Procedure.

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Clicking on the See your final position button, you can view your implanted Gamma3 Nail, the Lag Screw position and the distal locking directly in the femur, similar to a 3D CT scan. Navigate the virtual bone using your Keyboard Arrow Buttons. (see next page)

In order to quit the session please click onto the button on the right upper corner of your Internet Browser or use this EXIT PROGRAM button. Click the RESTART PROGRAM button for unlimited training, if you like to try again..

There will be a CD-version available soon and you can order it from SOD: http://www.strykerondemand.com/

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There are severals ways on different distal locking possibilities this program offers:

Start

Static Locking

Dynamic Locking

Alternative A

Alternative B

Alternative A

Alternative B

Double check with Screw Gauge?

no

yes

End Cap Insertion

Enjoy your Gamma3 Virtual Training Session! Stryker Trauma GmbH Prof.-Kntscher-Str. 1-5 24232 Schnkirchen / Kiel Germany http://www.osteosynthesis.stryker.com

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