Expert Tibial Nail Technique Guide

Introduction Expert Tibial Nail 2 AO Principles of Internal Fixation 4 Surgical technique Preoperative Planning 8 Product information Implant Specifications 60 C Image intensifier control Expert Tibial Nail PROtect 79 This description alone does not provide sufficient background for direct use of Optional: Angular Stable Locking System (ASLS) 80 the instrument set. Instruction by a surgeon experienced in handling these nstruments is highly recommended Reprocessing, Care and Maintenance of Synthes Instruments Cleaning of instruments: For general guidelines, function control and dismantling of...

Expert Tibial Nail Comprehensive solutions Versatile proximal locking options: – Three unique and innovative locking options, in combination with cancellous bone locking screws, increase the stability of the proximal fragment for proximal third fractures. – Two state of the art medio-lateral (ML) locking options enable primary compression or secondary controlled dynamization Improved stability Stardrive® T40 as th e Synthes ® lo som ck in g with hexalobu lar in 64 106 This pa tie n Technique Guide ISO Expert Tibial Nail ws re sc EN Synthes 5 mm e according driv to 2 0 mm al rn te End caps: –...

Advanced nail design: – New anatomic bend for ease of nail insertion – Titanium alloy TAN* for improved mechanical and fatigue properties – Cannulated nails (from л 8 mm to л 13 mm) for reamed or unreamed techniques, enabling nail insertion over guide wire – The 2.5 mm or 3.0 mm ball tipped guide wires may be removed through the nail and insertion handle assembly (no exchange tube required). – Solid nails (from л 8 mm to л 10 mm) for unreamed technique Advanced distal locking options: – Distal oblique locking option to prevent soft tissue damage and increase stability of the distal fragment –...

AO Principles of Internal Fixation In 1958, the Association for the Study of Internal Fixation (AO) formulated four basic principles1, which have become the guidelines for internal xation in general, and intramedullary nailing in particular: The Expert Tibial Nail permits an intramedullary approach for the fixation of proximal, shaft and distal fractures of the tibia. The system consists of a series of cannulated nails, cannulated 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...

The Expert Tibial Nail is indicated for fractures in the tibial shaft as well as for metaphyseal and certain intraarticular fractures of the tibial head and the pilon tibiale: - Combinations of these fractures For these indications the Expert Tibial Nail should be used in combination with other implants (not shown in the illustra- Note: The use of a cannulated Expert Tibial Nail with a large diameter offering more stability associated with the reamed technique is generally recommended for pseudarthroses, tumours, mal-unions and non-unions. Note: ASLS, the Angular Stable Locking System, is indicated...

Fracture involving the proximal component The use of the three locking screws in the proximal oblique locking options ensures optimal stabilization of the proximal fragment. The distal segment can be stabilized by using two ML locking options. Stability of the distal fragment can be enhanced by the use of a third locking screw in the AP Shaft fracture 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 the proximal static locking screw. Fracture involving the distal component...

preoperative postoperative follow-up (3 months after surgery) preoperative postoperative follow-up (4 weeks after surgery) Expert Tibial Nail Technique Guide Synthes 7

Preoperative Planning TM EXPERT Tibial Nail for Ø 8, 9, 10, 11, 12, 13 mm nails 15 10 5 0 mm 40 50 To estimate nail length, place the template on the AP X-ray of the uninjured tibia and select the appropriate nail length based on patient anatomy. When selecting nail size, consider canal diameter, fracture pattern, patient anatomy and postoperative protocol. dynam 04.004.0 03 04.004.0 02 04.004.0 01 04.004.0 00 (04.004.0 04) ic 7 mm 30 Cancellous Bone Locking Screw Ø 5.0 mm (golden) 04.015.5XX 0 mm Use the AO ASIF Preoperative Planner Template for the Expert Tibial Nail to estimate nail diameter...

Position patient C Position the patient supine on the radiolucent table. Ensure that the knee of the injured leg can be flexed at least 90°. Position the image intensifier such that 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 placed in traction. Note: The knee roller can be placed under the lower part of the thigh if it obstructs the view of the tibia plateau in AP Expert Tibial Nail Technique Guide Synthes

Reduce fracture Perform closed reduction manually by axial traction under mage intensifies The use of the Large Distractor (394.350) or Pinless Fixator (186.310) may be appropriate in certain Note: The reduction can be temporarily fixed with reduction clamps. In epiphyseal fractures the condyles or the pilon tibiale are fixed first in order to enable the nail insertion. 10 Synthes Expert Tibial Nail Technique Guide

3 Confirm nail length and diameter Instrument 03.010.021 Radiographic Ruler for Tibial Nails, length 450 mm The required nail length must be determined after reduction of the lower leg fracture. Position the C-arm for an AP view of the distal tibia. With long forceps, hold the ruler along the leg, parallel to and at the same level as the tibia. Adjust the ruler until the distal tip is at the level of the physeal scar or the desired nail insertion depth. Mark the skin at that site. Move the C-arm to the proximal tibia, replace the distal end of the ruler at the skin mark, and take an AP image...