4
It is mounted on the motor and introduced in an ascending, transosseous
manner, controlling its insertion on the image intensifi er
(Fig. 5)
.
It must be positionned exactly in the centre of the tibial pilon, both face on
and in profi le, with the hindfoot in its axis. The choice of introduction point
for the nail must be made very carefully as the nail cannot and must not re-
duce the hindfoot automatically.
The cortical bones are hollowed out
(Fig.6)
using a cannulated drill bit
(
ref.
253264
)
before inserting the hand reamers (
ref. 253248, 253249 and
253250
).
The length of the nail can be read using the graduations on the reamer in posi-
tion, as a projection of the external orifi ce of the retractor
(Fig. 7).
At this stage, it is recommended that the threaded tip pin be replaced by a
smooth key wire (
ref. 253245
). Reaming is performed size for size. It is possible
to use a mechanical reamer in cases of bone resistance or proceed this way if
you are used to.
IMPLANTATION OF THE NAIL
(Fig. 8)
The nail, the diameter and length aof which were determined previously, is
assembled on the main fi xation nail holder (
ref. 253246
), to which it is joined
by the M6 connecting screw (
ref. 253251
).
Depending on whether it is a right (R) or left (L) foot, the notch (R) or (L) in the
holder is placed opposite the arrow marked on the nail. The posterior guide is
joined to the holder by the M5 screw (
ref. 253681
), using the posterior face of
the nail marked B (back) as the orientation mark.
Before introducing the nail, it is recommended that the leg be raised by
means of a block or a pile of folded sterile drapes so as not to be hindered
by the posterior axis of the main fi xation nail holder. This is introduced on the
foam stem guide (
ref. 253245
), and crosses the subtalar and talocrural interli-
nes. The nail must be pushed in with the hammer, maintaining the correction
in the axis of the hindfoot, so that its distal extremity, visible on the image
intensifi er, lightly touches the inferior cortical of the calcaneus
(Fig. 9)
.
5 - Implantation of the threaded
pin with the motor
6 - Introduction of the cannulated drill
bit – Hollowing the cortical bones
7 - Introduction of the hand reamers
8 – Assembling the TYLOS™
posterior drill guide
9 - Introduction and implantation
of the nail
253264
253244
253258
253247
253248
253249
253250
253251
253246
254596
253681
254635
