Johnson & Johnson DePuy Synthes TRAUMA Titanium Cannulated Tibial Nail Surgical Technique Download Page 6

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Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma 5

IndIcatIonS

the tibial nail–ex is intended to stabilize fractures of the
proximal and distal tibia and the tibial shaft, open and closed
tibial shaft fractures, certain pre- and postisthmic fractures,
and tibial malunions and nonunions.

Summary of Contents for DePuy Synthes TRAUMA Titanium Cannulated Tibial Nail

Page 1: ...tItanIum cannulated tIbIal naIl Expert Nailing System SurgIcal technIque...

Page 2: ...ated Tibial Nail Expert Nailing System 2 AO Principles 4 Indications 5 Clinical Cases 6 Preoperative Planning 8 Opening the Tibia 9 Reaming optional 14 Inserting the Nail 15 Locking Options 19 Locking...

Page 3: ...lock the most proximal oblique locking screw to create a fixed angle construct x Gray end caps feature a lead in design for easier end cap insertion x End caps prevent ingrowth of tissue and facilita...

Page 4: ...provides better bone purchase in the near cortex and improved stability x Titanium alloy for improved mechanical and fatigue properties x Self tapping blunt tip x Self retaining T25 StarDrive recess...

Page 5: ...basic principles which have become the guidelines for internal fixation 1 They are Anatomic reduction Fracture reduction and fixation to restore anatomical relationships Stable fixation Stability by f...

Page 6: ...echnique DePuy Synthes Trauma 5 Indications The Tibial Nail EX is intended to stabilize fractures of the proximal and distal tibia and the tibial shaft open and closed tibial shaft fractures certain p...

Page 7: ...ary dynamization is achieved by removing the proximal static locking screw Fracture involving the distal component Case 2 The use of four distal locking screws is sometimes necessary to achieve stabil...

Page 8: ...ated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma 7 Clinical Cases Preoperative Follow up 3 weeks after surgery Preoperative Follow up 3 weeks after surgery Postoperative...

Page 9: ...of the medullary canal at the narrowest part that will contain the nail To estimate nail length place the template on the AP x ray of the uninjured tibia and select the appropriate nail length based o...

Page 10: ...he pilon are fixed first in order to enable the nail insertion Opening the Tibia 1 Position patient Position the patient supine on the radiolucent table Ensure that the knee of the injured leg can be...

Page 11: ...ctly from the ruler image selecting the measurement at or just below the level of the anterior edge of the tibial plateau When using the large distractor measure the distance from the inferior border...

Page 12: ...infrapatellar corpus adiposum laterally and dorsally without opening the synovia Free access of the nail to the insertion point must be guaranteed Prepare the entry site of the nail on the ventral edg...

Page 13: ...nch mark the insertion point at a 10 angle to the shaft axis in the lateral view Hold a sterile nail on the side of the lower leg with its distal end parallel to the tibia shaft The curved proximal na...

Page 14: ...ill to a depth of approximately 8 cm 10 cm The guide wire and the drill bit should not touch the posterior cortex Remove the guide wire drill bit and protection sleeve Note Dispose of the guide wire D...

Page 15: ...reduction under the image intensification Inserting the reaming rod Insert the reaming rod with ball tip into the medullary canal using the holding device to the desired insertion depth Reaming Start...

Page 16: ...fy the nail is oriented properly on the insertion handle secure the assembly with the 8 mm ball hex screwdriver Alternative instruments 03 010 017 Tibial Nail EX Insertion Handle 03 010 145 Cannulated...

Page 17: ...ng arm may loosen during nail insertion Optional instruments 03 010 047 Driving Cap 03 010 056 Slide Fixed Hammer 700 grams 321 17 4 5 mm Pin Wrench 321 20 11 mm Ratchet Wrench 357 22 Hammer Guide for...

Page 18: ...ach the aiming arm and insert a 3 2 mm guide wire through the hole as shown in the illustration The tip of the guide wire indicates the exact proximal position of the tibial nail Remove the driving ca...

Page 19: ...AP and lateral views Remove the reaming rod Important Confirm that the nail is securely connected to the insertion handle especially after hammering using either the 8 mm ball hex screwdriver or the...

Page 20: ...l fragments caused by the quadriceps mechanism and relieves the pressure on the soft tissue usually associated with tibial nail insertion instruments This position also facilitates assessment of rotat...

Page 21: ...ical Technique 14 mm 20 mm 30 mm Distal oblique Proximal oblique AP 36 mm 7 mm Stat 2 Dynamic Stat 1 5 mm 22 mm AP Oblique 37 mm ML ML 13 mm 57 mm For anterolateral or anteromedial locking 30 to the s...

Page 22: ...technique to prevent loss of reduction Verify the nail has been inserted to the appropriate depth Locking of the tibial nail is usually performed from the medial side if possible with the leg extended...

Page 23: ...of the fragments and leg length before locking the nail Align the C arm with the hole in the nail closest to the fracture until a perfect circle is visible in the center of the screen Distal ML hole...

Page 24: ...of the drill bit is centered over the locking hole The drill bit should almost completely ll the circle of the locking hole Hold the drill bit in this position and drill through both cortices Techniq...

Page 25: ...Three Fluted Drill Bit quick coupling 145 mm 03 010 106 Direct Measuring Device for Locking Screws to 100 mm for IM Nails Stop drilling immediately after both cortices and disassemble the drill bit f...

Page 26: ...strument 03 010 072 Depth Gauge for Locking Screws to 100 mm for IM Nails Measure the locking screw length using the depth gauge for locking screws Ensure the outer sleeve is in contact with the bone...

Page 27: ...d after insertion of the second distal locking screw Alternatively the compression device can be used refer to page 31 Use the holding sleeve as described below a Insert the holding sleeve onto the sh...

Page 28: ...e of locking allows primary compression or secondary controlled dynamization of the bone fragments 2 Static 2 STAT 2 corresponds to the lower position of the proximal locking slot This type of locking...

Page 29: ...rill bits These forces may prevent accurate targeting through the proximal locking holes and damage the drill bits 3 Insert trocar combination Instruments 03 010 063 12 0 mm 8 0 mm Protection Sleeve 1...

Page 30: ...tion Ensure that the drill sleeve is pressed rmly to the near cortex and read the measurement from the calibrated drill bit at the back of the drill sleeve This measurement corresponds to the appropri...

Page 31: ...ing screw through the protection sleeve using the T25 StarDrive screwdriver Verify locking screw length under image intensification The tip of the locking screw should not project more than 1 mm 2 mm...

Page 32: ...shed without removing the insertion instruments The Tibial Nail EX allows a maximum compression of 7 mm If more compression of the fracture gap is needed the conventional backslap technique is recomme...

Page 33: ...ting screw and into the nail using the 8 mm ball hex screwdriver The compression device will contact the dynamic locking screw Advance the compression device until the fracture gap is reduced Monitor...

Page 34: ...cking screw in the most distal hole of the proximal locking options Static 1 Refer to section Diaphyseal and Distal Segment Fractures on pages 27 to 30 Remove the compression device Additional oblique...

Page 35: ...on also facilitates assessment of rotational alignment prior to locking Use the dual core locking screws gold only in combination with the two oblique proximal locking holes PROXIMAL OBLIQUE DISTAL OB...

Page 36: ...special attention To avoid lesion of the popliteal artery the tibial nerve and the common peroneal nerve as well as damage to the proximal tibio bular joint drilling must be stopped immediately befor...

Page 37: ...ial Nail EX 03 010 092 Ball Hex Screwdriver 8 mm Confirm that the nail is securely connected to the insertion handle using the 8 mm ball hex screwdriver Mount the aiming arm to the insertion handle as...

Page 38: ...on protection sleeve corresponding drill sleeve and trocar through the desired hole for oblique locking options in the aiming arm make a stab incision and insert the trocar to the bone Remove the troc...

Page 39: ...rter dual core locking screw Important Do not perforate the far cortex with the drill bit Do not damage the tibial plateau Con rm drill bit position after drilling Ensure that the drill sleeve is pres...

Page 40: ...rt dual core locking screws Instrument 03 010 107 StarDrive Screwdriver T25 self retaining Insert the appropriate 5 0 mm dual core locking screw through the protection sleeve using the T25 StarDrive s...

Page 41: ...Locking Proximal Segment Fractures Option Repeat the same steps as described above for the third proximal dual core locking screw in the AP direction The position of the dual core locking screw shoul...

Page 42: ...lique screw providing a stable fixed angle construct The gray end caps have a lead in design for easier end cap insertion These are only used for standard transverse proximal locking The two proximal...

Page 43: ...ial pressure To prevent cross threading align the end cap with the nail axis and turn the end cap counterclockwise until the thread of the end cap aligns with that of the nail Turn the end cap clockwi...

Page 44: ...Holding Sleeve with Locking Device Implant removal is an optional procedure Clear the StarDrive socket of the end cap and the locking implants of any tissue ingrowth Remove the end cap with the T40 St...

Page 45: ...7 22 Hammer Guide Before removing the final locking screw screw the extraction screw into the tibial nail and tighten it to prevent rotation or displacement of the nail posteriorly below the tibial pl...

Page 46: ...ted Connection Screw 355 399 Extraction Hook for Titanium Cannulated Nails 357 133 Extraction Screw 393 10 Universal Chuck with T Handle or 393 105 Small Universal Chuck with T Handle 1 Clear tissue f...

Page 47: ...mm larger than the diameter to clear a path for the distant nail fragment 6 Insert the extraction hook and explanted near nail fragment into the medullary canal The near nail fragment aligns the extr...

Page 48: ...r screws with the appropriate screwdriver 3 Insert the extraction hook into the universal chuck with T handle The hook should be parallel with the T handle This facilitates visualization of the hook p...

Page 49: ...mm x 11 mm 13 mm nails have a proximal diameter consistent with the shaft diameter Colors x 8 mm and 9 mm blue use 4 0 mm titanium locking screws blue x 10 mm 13 mm green use 5 0 mm titanium locking s...

Page 50: ...4 004 455S 390 04 004 258S 04 004 358S 04 004 458S 405 04 004 261S 04 004 361S 04 004 461S 420 04 004 264S 04 004 364S 04 004 464S 435 04 004 267S 04 004 367S 04 004 467S Length 11 mm dia 12 mm dia 13...

Page 51: ...anium Dual Core Locking Screws with T25 StarDrive recess for IM Nails gold Length mm Length mm 04 015 520 30 04 015 555 65 04 015 525 35 04 015 560 70 04 015 530 40 04 015 565 75 04 015 535 45 04 015...

Page 52: ...mm 04 005 440 50 04 005 442 52 04 005 444 54 04 005 446 56 04 005 448 58 04 005 450 60 04 005 452 62 04 005 454 64 04 005 456 66 04 005 458 68 04 005 460 70 04 005 462 72 04 005 464 74 04 005 466 76...

Page 53: ...05 518 28 04 005 520 30 04 005 522 32 04 005 524 34 04 005 526 36 04 005 528 38 04 005 530 40 04 005 532 42 04 005 534 44 04 005 536 46 04 005 538 48 04 005 540 50 04 005 542 52 04 005 544 54 04 005 5...

Page 54: ...04 025 418S 28 04 025 446S 56 04 025 420S 30 04 025 448S 58 04 025 422S 32 04 025 450S 60 04 025 424S 34 04 025 452S 62 04 025 426S 36 04 025 454S 64 04 025 428S 38 04 025 456S 66 04 025 430S 40 04 0...

Page 55: ...2 per package Resorbable Sleeve for Angular Stable Locking Screws sterile 2 pkg 08 025 032S for 4 0 mm ASLS Screws 08 025 044S for 5 0 mm ASLS Screws ASLS Compatibility with Existing Nails The Angula...

Page 56: ...StarDrive recess for Titanium Tibial Nails EX gold x Securely lock the proximal oblique dual core locking screw Extension mm 04 004 000 0 04 004 001 5 04 004 002 10 04 004 003 15 Titanium End Caps wit...

Page 57: ...3 010 021 Radiographic Ruler for Titanium Cannulated Tibial Nails 03 010 023 Radiographic Canal Width Estimator for IM Nails 03 010 035 12 0 mm Protection Sleeve 03 010 024 Holding Device for Guide Wi...

Page 58: ...03 010 052 Aiming Arm for Titanium Cannulated Tibial Nails EX 03 010 045 Standard Insertion Handle 03 010 047 Driving Cap with Handle Adapter 03 010 056 Slide Fixed Hammer 700 grams 03 010 040 12 0 mm...

Page 59: ...it quick coupling 330 mm 100 mm calibration 03 010 063 12 0 mm 8 0 mm Protection Sleeve 188 mm 03 010 064 8 0 mm 3 2 mm Drill Sleeve 200 mm 03 010 065 8 0 mm 4 2 mm Drill Sleeve 200 mm 03 010 069 3 2...

Page 60: ...145 mm 03 010 104 4 2 mm Three Fluted Drill Bit quick coupling 145 mm 03 010 092 Ball Hex Screwdriver 8 mm 03 010 106 Direct Measuring Device for locking screws to 100 mm for IM nails 03 010 107 StarD...

Page 61: ...5 mm Pin Wrench 120 mm 321 20 Ratchet Wrench 11 mm width across flats 357 22 Hammer Guide for Slide Hammer 357 133 Extraction Screw for Titanium Femoral and Tibial Nails 357 398 Cannulated Shaft with...

Page 62: ...ith Handle Adapter 03 010 052 Aiming Arm for Titanium Cannulated Tibial Nails EX 03 010 056 Slide Fixed Hammer 700 grams 03 010 060 3 2 mm Three Fluted Drill Bit quick coupling 330 mm 100 mm calibrati...

Page 63: ...e Screwdriver T25 self retaining 03 010 110 Cannulated StarDrive Screwdriver T40 self retaining 03 010 112 Holding Sleeve with Locking Device 321 17 4 5 mm Pin Wrench 120 mm 2 ea 321 20 Ratchet Wrench...

Page 64: ...04 002 10 04 004 003 15 Titanium End Caps with T40 StarDrive recess extended tip for Tibial Nails EX gray 2 ea Extension mm 04 004 008 0 04 004 009 5 04 004 010 10 04 004 011 15 5 0 mm Titanium Dual C...

Page 65: ...28 04 005 520 30 04 005 522 32 04 005 524 34 04 005 526 36 04 005 528 38 04 005 530 40 04 005 532 42 04 005 534 44 04 005 536 46 04 005 538 48 04 005 540 50 04 005 542 52 Implants 4 0 mm Titanium Lock...

Page 66: ...l Expert Nailing System Surgical Technique DePuy Synthes Trauma 66 Tibial Nail EX Instrument and Titanium Implant Set 01 004 300 01 004 300 consists of 01 004 303 Tibial Nail EX Instrument Set 01 004...

Page 67: ...ble Locking System Screw Set 5 0 mm Titanium Angular Stable Locking Screws with T25 StarDrive recess for intramedullary nails sterile 2 ea Length Length mm mm 04 025 520S 30 04 025 550S 60 04 025 522S...

Page 68: ...ercutaneous Insertion Handle 03 010 100 3 2 mm Three Fluted Drill Bit quick coupling 145 mm for Radiolucent Drive 03 010 101 4 2 mm Three Fluted Drill Bit quick coupling 145 mm for Radiolucent Drive 0...

Page 69: ...a a division of DOI 2013 All rights reserved J6471 F 1 14 Synthes Canada Ltd 2566 Meadowpine Boulevard Mississauga Ontario L5N 6P9 Telephone 905 567 0440 To order 800 668 1119 Fax 905 567 3185 CAUTION...

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Johnson & Johnson DePuy Synthes TRAUMA Titanium Cannulated Tibial Nail, Surgical Technique

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