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Synthes

Expert Tibial Nail

AO/ASIF Principles of
internal fixation

1

M.E. Müller, M. Allgöwer, R. Schneider y R. Willenegger:

Manual de osteosíntesis, 3ª edición. Barcelona: Springer-Verlag Ibérica. 1991

* Titanio, 6%; aluminio, 7%; niobio

In 1958, the AO/ASIF (Association for the Study of Internal
Fixation) formulated four basic principles

1

, which have

become the guidelines for internal ﬁxation in general, and in-
tramedullary nailing in particular:

The Expert Tibial Nail permits an intra medullary approach for
the fixation of proximal, shaft and distal fractures of the
tibia. The system consists of a series of cannulated nails, can-
nulated end caps, dual core locking screws and standard
locking screws. All of the implants are made of titanium alloy
(TAN*).

Anatomic Reduction

The Expert Tibial Nail is designed to fit anatomically in the
medullary canal, allowing indirect reduction of proximal,
distal and shaft fractures of the tibia.

Stable Fixation

The Expert Tibial Nail provides stable fixation of fractures by
incorporating oblique locking holes in the proximal and distal
portions of the nail.

Cancellous bone locking screws are used proximally for
better purchase in the cancellous bone. The most proximal
locking screw, when used with an end cap, provides a
locked, fixed-angle construct. Locking screws in the distal
oblique hole and ML hole provide stable fixation of distal
fractures.

Preservation of Blood Supply

The instruments and implants in the Expert Tibial Nail permit
a more percutaneous technique and less tissue stripping
than other treatment methods. An intramedullary approach
results in decreased blood loss compared to plate fixation.

Early, Active Mobilization

The Expert Tibial Nail provides secure fixation which permits
controlled, early, active rehabilitation conducive to optimal
recovery.

0X6.000.380_AC.qxp:0X6.000.380_AC 20.01.2009 10:31 Uhr Seite 4

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Содержание Expert Tibial Nail

Страница 1: ...Expert Nailing System Expert Tibial Nail Technique Guide 0X6 000 380_AC qxp 0X6 000 380_AC 20 01 2009 10 31 Uhr Seite Cvr1...

Страница 2: ...0X6 000 380_AC qxp 0X6 000 380_AC 20 01 2009 10 31 Uhr Seite Cvr2...

Страница 3: ...end cap 55 Weight bearing 57 Implant removal 58 Implant specifications 61 Implants 62 Instruments 69 Warning This description is not suf cient for immediate application of the instrumentation Instruct...

Страница 4: ...tion Self retaining Stardrive T40 recess for effortless end cap pick up and ease of insertion Cannulated 0 mm end cap sits flush with nail 5 10 and 15 mm end caps extend nail height if nail is over in...

Страница 5: ...terior AP locking options for stability of the distal fragment All locking screws Double lead thread for more contact points for enhanced stability and ease of insertion Thread closer to screw head pr...

Страница 6: ...canal allowing indirect reduction of proximal distal and shaft fractures of the tibia Stable Fixation The Expert Tibial Nail provides stable fixation of fractures by incorporating oblique locking hol...

Страница 7: ...nations of these fractures For these indications the Expert Tibial Nail should be used in combination with other implants not shown in the illustra tions 41 C1 C2 43 C1 C2 Note The use of a cannulated...

Страница 8: ...Shaft fracture Case 2 For simple shaft fractures two proximal ML and two distal ML locking screws are normally sufficient to stabilize the fracture Secondary dynaminization is achieved by removing th...

Страница 9: ...ollow up 3 weeks after surgery preoperative postoperative follow up 1 month after surgery preoperative postoperative follow up 4 months after surgery preoperative 0X6 000 380_AC qxp 0X6 000 380_AC 20...

Страница 10: ...lue 04 005 4XX 0 mm 18 30 40 50 60 70 80 04 004 000 04 004 004 7 mm 9 mm 10 mm 11 mm 12 mm 13 mm Manufacturer Stratec Medical Eimattstrasse 3 CH 4436 Oberdorf www synthes com 8 Synthes Expert Tibial N...

Страница 11: ...visualisation of the tibia including the articular surface proximally and distally is possible in AP and lateral views Optionally the procedure can be performed on a fracture table with the leg place...

Страница 12: ...Distractor 394 350 or Pinless Fixator 186 310 may be appropriate in certain circumstances Note The reduction can be temporarily xed with reduction clamps In epiphyseal fractures the condyles or the p...

Страница 13: ...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 of the distal...

Страница 14: ...teed Prepare the entry site of the nail on the ventral edge of the tibial plateau Alternatives Determine the nail length by the above procedure on the un injured leg or before draping unsterile or com...

Страница 15: ...for proximal and distal third fractures to prevent fragment displacement In AP view the entry point is in line with the axis of the intra medullary canal and with the lateral tubercle of the inter co...

Страница 16: ...t axis in the lateral view Hold a sterile Expert Tibial Nail on the side of the lower leg with its distal end parallel to the tibia shaft The curved proximal nail end determines the de nitive angle of...

Страница 17: ...0 035 Protection Sleeve 14 0 12 0 length 161 mm Push the protection sleeve and the cutter over the guide wire and open the medullary canal to a depth of 8 10 cm The guide wire and the cutter should no...

Страница 18: ...15 03 010 035 Protection Sleeve 14 0 12 0 length 161 mm Place the protection sleeve and the drill bit over the guide wire and down to the bone Drill to a depth of approx 8 10 cm The guide wire and the...

Страница 19: ...mm cannulated length 243 mm Place the cannulated awl over the guide wire and open the medullary canal Use a twisting motion to advance the awl to a depth of approx 8 10 cm The awl should not touch th...

Страница 20: ...the medullary canal to the desired insertion depth Reaming Starting with the 8 5 mm reaming head ream to a diame ter of 0 5 1 5 mm greater than the nail diameter Ream in 0 5 mm increments and advance...

Страница 21: ...Synthes 19 Option Use the rod pusher to help retain the reaming rod during reamer extraction 0X6 000 380_AC qxp 0X6 000 380_AC 20 01 2009 10 31 Uhr Seite 19...

Страница 22: ...xagonal with spherical head 8 0 mm Orient the insertion handle anteriorly and match the notch on the handle to the nail Place the connecting screw into the insertion handle and thread it into the prox...

Страница 23: ...or Reaming Rod with Hexagonal Screwdriver 8 0 mm Optionally slide the connecting screw onto the rod pusher Slide the assembly through the insertion handle and match the notch on the handle to the nail...

Страница 24: ...he nail passage across the fracture control in two planes to avoid malalignment Insert the nail until it is at or below the tibial opening Check nal nail position in AP and lateral views Note For prox...

Страница 25: ...ing the nut onto the threads located below the hammer head using the pin wrench if necessary Strike the connector directly Optionally the hammer guide can be threaded into the con nector and the hamme...

Страница 26: ...ck proximal nail position under image intensification in the lateral view Note The distance between the markings on the insertion handle is 5 mm and corresponds to the extensions of the end caps This...

Страница 27: ...Important Confirm that the nail is securely connected to the insertion handle especially after hammering Note Insertion depth is critical for distal third fractures where a minimum of two locking scr...

Страница 28: ...soft tissue usu ally associated with tibial nail insertion instruments This posi tion also facilitates assessment of rotational alignment prior to locking Diaphyseal segment fractures For diaphyseal...

Страница 29: ...Synthes 27 Locking holes 8 mm 9 mm 11 mm 12 mm 13 mm 10 mm 0 mm 14 mm 20 mm 30 mm 36 mm 43 mm 57 mm 37 mm 22 mm 13 mm 5 mm 0 mm 0X6 000 380_AC qxp 0X6 000 380_AC 20 01 2009 10 31 Uhr Seite 27...

Страница 30: ...de if possible with the leg extended This position helps counteract the forces exerted by the quadriceps muscle that would tend to deform the proximal fragment and also facili tates rotational control...

Страница 31: ...sion 2 Align the image Check the reduction correct alignment of the fragments and leg length before locking the nail Align the C arm with the hole in the nail closest to the frac ture until a perfect...

Страница 32: ...through the incision down to the bone Incline the drive so that the tip of the drill bit is centered over the locking hole The drill bit should almost completely ll the circle of the locking hole Hold...

Страница 33: ...Quick Coupling 03 010 104 Drill Bit 4 2 mm calibrated length 145 mm 3 ute for Quick Coupling Standard freehand locking technique can be performed with out the radiolucent drive Use the appropriate dr...

Страница 34: ...ices and disassemble the drill bit from the Radiolucent Drive Ensure the correct position of the drill bit beyond the far cortex Place the direct measuring device onto the drill bit Read the graduatio...

Страница 35: ...strument 03 010 072 Depth Gauge for Locking Screws Measure the screw length using the depth gauge Ensure the outer sleeve is in contact with the bone and the hook grasps the far cortex Read the screw...

Страница 36: ...used after insertion of the second distal locking screw Alternatively the compression screw can be used please refer to step 26 page 34 Use the holding sleeve as described below a Insert the holding...

Страница 37: ...king screw drill sleeve trocar and drill bit for the selected nail diameter as shown in the table Three proximal ML locking options can be targeted using the aiming arm 1 The dynamic locking option DY...

Страница 38: ...handle use the blue and green marked guided holes Mount the aiming arm to the insertion handle Note Do not exert forces on the aiming arm protection sleeve drill sleeves and drill bits These forces ma...

Страница 39: ...with green marking 03 010 069 Trocar 3 2 mm for No 03 010 063 with blue and yellow marking 03 010 070 Trocar 4 2 mm for No 03 010 063 with green marking Insert the three part trocar combination prote...

Страница 40: ...ing the corresponding drill bit 3 2 mm for 4 0 mm locking screws or 4 2 mm for 5 0 mm locking screws drill through both cortices until the tip of the drill bit penetrates the far cortex Confirm drill...

Страница 41: ...the outer sleeve and the measuring device with hook Insert the measuring device into the protection sleeve Make sure that the hook grasps the far cortex and that the protection sleeve is on the bone R...

Страница 42: ...cation The tip of the locking screw should not project more than 1 2 mm beyond the far cortex Repeat the steps 3 to 5 for the second proximal ML locking Screw Option Additional cancellous bone locking...

Страница 43: ...ows for a maximum compression of 7 mm If more compression of the fracture gap is needed the conventional backstroke technique is recommended Note Distal locking is required prior to compression lockin...

Страница 44: ...ough the connecting screw and into the nail using the screwdriver The compression screw will contact the dynamic locking screw Advance the compression screw until the fracture gap is re duced Monitor...

Страница 45: ...cond proximal locking screw in the most distal hole of the proximal locking options Static 1 refer to steps 1 to 5 on pages 35 to 40 Remove the compression screw Additional oblique cancellous bone loc...

Страница 46: ...hole for all nail diameters Use the 3 2 mm drill bit 03 010 060 with blue and yellow markings for the cancellous bone locking screws gold The aiming arm can target all three proximal oblique locking...

Страница 47: ...as damage to the proximal tibio bular joint drilling must be stopped immediately be fore penetrating the far cortex In case of C type fractures of the tibial head the articulation surface of the prox...

Страница 48: ...the tibial plateau Cannulated screws Using TAN screws is strongly recommended The following cannulated screws can be considered Cannulated Screws 6 5 mm TAN dark blue 408 401 408 482 Cannulated Screws...

Страница 49: ...rtion handle Mount the aiming arm to the insertion handle as shown in the illustration Note Do not exert forces on the aiming arm protection sleeve drill sleeves and drill bits These forces may preven...

Страница 50: ...l Bit 3 2 mm calibrated length 340 mm 3 ute for Quick Coupling with blue and yellow marking Insert the protection sleeve and the drill sleeve through the oblique guide hole OBLI 1 of the aiming arm In...

Страница 51: ...one locking screw If necessary insert the nail more distally Note It is important that the cannulated screws and the cancel lous bone locking screws do not interfere and that the cancellous bone locki...

Страница 52: ...oblique locking option can be checked similarly to the technique described above by using the oblique guide hole OBLI 2 of the aiming arm and corre sponding guide hole for the drill bit Proximal lock...

Страница 53: ...ng 03 010 069 Trocar 3 2 mm for No 03 010 063 with blue and yellow marking Insert the three part trocar combination protection sleeve corresponding drill sleeve and trocar through the desired hole for...

Страница 54: ...after penetrating the near cortex DO NOT penetrate the far cortex Monitor the position of the drill bit with image intensifica tion This can be done by orienting the image intensifier per pendicular...

Страница 55: ...d perforation of the far cortex with the cancellous bone locking screw it is recommended to choose a cancellous bone locking screw 5 mm shorter than the measured length 7 Insert cancellous bone lockin...

Страница 56: ...of the cancellous bone locking screw should be controlled under image intensi cation to ensure a correct po sition of the AP cancellous bone locking screw Repeat this procedure for the second cancell...

Страница 57: ...s overinserted and they lock the proximal oblique screw or the distal oblique locking screw providing a stable fixed angle construct The end caps are cannulated for use over a guide wire if nec essary...

Страница 58: ...g align the end cap with the nail axis and turn the end cap counter clockwise until the thread of the end cap aligns with that of the nail Turn the end cap clockwise to thread the end cap into the nai...

Страница 59: ...Partial weight bearing sole contact or 15 kg is the basic form of loading the fractured leg Complete non weight bearing should be avoided Increase in load is determined according to fracture pattern a...

Страница 60: ...ar the Stardrive socket of the end cap and the locking from any tissue ingrowth Remove the end cap with the screwdriver Stardrive T40 Remove all locking screws except one of the proximal locking screw...

Страница 61: ...th 330 mm Before removing the nal locking screw screw the extraction screw into the nail and tighten it to prevent rotation or displacement of the nail posteriorly below the tibial plateau Attach the...

Страница 62: ...xtraction of intramedullary femoral and tibial nails Before removing the nal locking screw screw the extraction screw into the nail and tighten it to prevent rotation or displacement of the nail poste...

Страница 63: ...1 mm increments 8 mm 10 mm nails have a proximal diameter of 11 mm 11 mm 13 mm nails have a proximal diameter consistent with the shaft diameter Colors 8 mm and 9 mm dark blue use 4 0 mm locking scre...

Страница 64: ...4 246 04 004 346 04 004 446 345 04 004 249 04 004 349 04 004 449 360 04 004 252 04 004 352 04 004 452 375 04 004 255 04 004 355 04 004 455 390 04 004 258 04 004 358 04 004 458 405 04 004 261 04 004 36...

Страница 65: ...04 004 746 345 04 004 549 04 004 649 04 004 749 360 04 004 552 04 004 652 04 004 752 375 04 004 555 04 004 655 04 004 755 390 04 004 558 04 004 658 04 004 758 405 04 004 561 04 004 661 04 004 761 420...

Страница 66: ...315 04 024 243 04 024 343 04 024 443 330 04 024 246 04 024 346 04 024 446 345 04 024 249 04 024 349 04 024 449 360 04 024 252 04 024 352 04 024 452 375 04 024 255 04 024 355 04 024 455 390 04 024 258...

Страница 67: ...ncellous bone larger core 4 3 mm to withstand load bearing from the nail Stardrive T25 recess Fully threaded Self tapping blunt tip Available non sterile or sterile packed Add S to the catalogue numbe...

Страница 68: ...4 005 444 54 04 005 414 24 04 005 446 56 04 005 416 26 04 005 448 58 04 005 418 28 04 005 450 60 04 005 420 30 04 005 452 62 04 005 422 32 04 005 454 64 04 005 424 34 04 005 456 66 04 005 426 36 04 00...

Страница 69: ...No Length mm 04 005 516 26 04 005 518 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 0...

Страница 70: ...flush with end of nail 5 mm 10 mm and 15 mm extensions Extend nail height if nail is overinserted Article No Extension in mm 04 004 000 0 04 004 001 5 04 004 002 10 04 004 003 15 Securely locks the s...

Страница 71: ...de Wire 3 2 mm 393 100 Universal Chuck with T Handle 03 010 008 Cutter for Tibial Nails 12 0 mm length 350 mm 03 010 035 Protection Sleeve 14 0 12 0 03 010 044 Connecting Screw for Tibial and Femoral...

Страница 72: ...Connector length 141 mm for Aiming Arm 321 160 Combination Wrench 11 mm 321 170 Pin Wrench 4 5 mm 357 220 Hammer Guide for No 357 250 Also suitable for No 03 010 056 03 010 045 Insertion Handle for T...

Страница 73: ...ute with Coupling for RDL 03 010 101 Drill Bit 4 2 mm length 145 mm 3 ute with Coupling for RDL 03 010 106 Direct Measuring Device for Drill Bits of length 145 mm for Nos 03 010 100 105 03 010 107 Scr...

Страница 74: ...0 063 Protection Sleeve 12 0 8 0 length 188 mm 03 010 064 Drill Sleeve 8 0 3 2 for No 03 010 063 03 010 065 Drill Sleeve 8 0 4 2 for No 03 010 063 03 010 069 Trocar 3 2 mm 03 010 070 Trocar 4 2 mm Ins...

Страница 75: ...044 03 010 110 Screwdriver Stardrive T40 cannulated length 300 mm 03 010 000 Extraction Screw for Tibial and Femoral Nails 03 010 060 Drill Bit 3 2 mm calibrated length 340 mm 3 ute for Quick Coupling...

Страница 76: ...0 011 03 010 007 Compression Screw for Tibial Nail for No 03 010 014 Radiolucent Instrumentation Alternative 03 010 013 Insertion Handle for Tibial Nail radiolucent short 03 010 095 Connecting Screw c...

Страница 77: ...adiolucent 357 117 Hammer Guide for DFN for No 357 026 03 010 124 Combined Hammer 500 g can be mounted 189 060 SynReam Intramedullary Reaming System 03 010 093 Rod Pusher for Reaming Rod with Hexagona...

Страница 78: ...ll Bit 3 2 mm length 145 mm 3 ute for Quick Coupling 03 010 104 Drill Bit 4 2 mm length 145 mm 3 ute for Quick Coupling 03 010 009 Protection Sleeve 12 0 8 0 length 128 mm 03 010 073 Drill Sleeve 8 0...

Страница 79: ...mm calibrated length 270 mm 3 ute for Quick Coupling 03 010 019 Depth Gauge for Locking Screws measuring range up to 110 mm for No 03 010 009 03 010 001 Extraction Screw for Tibial and Femoral Nails f...

Страница 80: ...ibial Nail 68 004 001 Vario Case for Expert Tibial Nails Titanium Alloy incl Locking Screws and End Caps without Lid without Contents VarioCase Instruments 0X6 000 380_AC qxp 0X6 000 380_AC 20 01 2009...

Страница 81: ...Instruments for Expert Tibial Nail without Lid without Contents 68 004 003 Vario Case for Radiolucent Instruments for Expert Tibial Nail without Lid without Contents not shown here 0X6 000 380_AC qxp...

Страница 82: ...for drill bits 511 761 Large Quick Coupling 511 785 Reduction Drive Unit 511 790 Quick Coupling for Kirschner wires 530 010 Power Drive complete 530 100 Power Drive 530 200 Battery for Power Drive 530...

Страница 83: ...0X6 000 380_AC qxp 0X6 000 380_AC 20 01 2009 10 31 Uhr Seite Cvr3...

Страница 84: ...0 SE_001078 AC 30060046 Synthes 2006 Expert Stardrive and Vario Case are trademarks of Synthes Subject to modifications Presented by 036 000 380 AC7 0X6 000 380_AC qxp 0X6 000 380_AC 20 01 2009 10 31...

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