Vous êtes sur la page 1sur 32

Expert™ Tibia Nail

Objectives
• Indication
• Design, Feature, Benefit
• Surgical techique
Indication
• Fractures in the tibial shaft
• Metaphyseal and certain
intraarticular
• Fractures of the tibial head and
the pilon tibiale
Anatomical design
I. Insertion of distal part Bend
starts when distal tip contacts
far cortex
II. Insertion of nail Continuous
radius, allows nail glides
through insertion canal
III. Inserted nail Straight part
higher than isthmus
Nail Range
• Cannulated nails:
• Ø 8 & 9mm
• Ø 10, 11, 12, 13mm
• Ø 8-10 are round, Ø 11-13 are
fluted
• 10.5º bend, transitional radius
dependent on nail length &
straight distal section (Standard
Locking Screw & End Caps
Indicated for the three proximal locking options of all tibial nails diameters
Cancellous
bone Dual core design for optimized purchase in cancellous bone
locking Unicortical
screws
Lengths: 30 mm–90 mm

Ø 4.0 mm for Ø 8.0 mm and Ø 9.0 mm tibial nails, lengths: 18 mm–80 mm


Standard
locking Ø 5.0 mm for Ø 10.0 mm to Ø 13.0 mm tibial nails
screws
Lengths: 26 mm–100 mm

Securely lock the most proximal oblique locking screw to create a fixed-angle
End Caps construct
End cap prevents ingrowth of tissue and facilitates nail extraction

Cannulated
Proximal Locking Options

Increases stability proximally

Multiple locking options

Multiple directions

Very proximal positions


Distal Locking Options
Distal oblique locking
To prevent soft tissue damage and increase Stability of the distal fragment
Two Medio Lateral and
one antero-posterior (AP)
locking For stability of the distal fragment
Insertion Angle
• Knee flexion of more than 90°may be
needed to insert nail
• Starting path: parallel to the anterior
cortex of the tibia
• 10° to the shaft axis
Compressing the Fracture Gap

2 methods
• Backslap
• Use of compression screw (7mm
only)

Remember to over insert nail &


lock distally before compressing
Tips for proximal nailing

Obtain good reduction prior to nail insertion

Maintain reduction during insertion of nail

Must use correct insertion point

Correct insertion angle

Lock proximally first

Use all 3 proximal screws for optimal stability


Tips for Distal Fractures
• Good reduction
• Start with distal locking first
• Is it an ankle fracture?
• Yes: Fibula should (must) be fixed
• No: Fibula may be fixed
• Use three screws in different directions
Expert™ Tibia Nail
Surgical Technique
Patient Positioning
Approach
Entry Point
In AP view

• In line with the axis of the intra-


medullary canal and with the lateral
tubercle of the inter-condylar
eminence.

In lateral view

• At the ventral edge of the tibial


plateau.
Insert guide wire
Open medullary canal
Awl Drill bit
Inserting Nail
Locking options
Proximal segment fractures

• For proximal fractures, it is recommended to lock the


nail with the knee in extension. This neutralizes the
deforming forces on proximal 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 rotational alignment prior to locking.

Diaphyseal segment fractures

• For diaphyseal fractures, it is recommended to lock


distally first to allow intraoperative compression.

Distal segment fractures

• For distal fractures, it is recommended to lock distally


first to facilitate reduction.
Distal Locking
Determine the length of Locking Screw
Distal Locking Options
Distal oblique locking
To prevent soft tissue damage and increase Stability of the distal fragment
Two Medio Lateral and
one antero-posterior (AP)
locking For stability of the distal fragment
Proximal locking
Compression locking mode
Oblique proximal locking
Oblique proximal locking

Stop drilling immediately after penetrating the near cortex.

DO NOT penetrate the far cortex


Insert End Cap
Nail Removal
• Remove all locking screws
except one to facilitate
attaching extraction screw
• Attach extraction screw and
hammer guide, remove
remaining locking screw and
backslap nail out
ETN Instrument Set
Resources
• ETN Surgical Technique DSEM-TRM-0814-0173-1_LR.pdf