Johnson & Johnson DePuy Synthes TRAUMA Titanium Cannulated Tibial... User manual

TITANIUM
CANNULATED
TIBIAL NAIL
Expert Nailing System
SURGICAL TECHNIQUE

Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma
INTRODUCTION
SURGICAL TECHNIQUE
PRODUCT INFORMATION
TABLE OF CONTENTS
Titanium Cannulated 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 Holes 20
Distal Locking 21
Proximal Locking 27
End Cap Insertion 41
Implant Removal 43
Implant Specifications 48
Implants 49
Instruments 56
Set Lists 61
Image intensifier control

2 DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique
IMPROVED STABILITY
ADVANCED SOLUTIONS
Advanced proximal locking options
xThree innovative locking options, in
combination with dual core locking
screws, to increase the stability of
the proximal fragment for proximal
third fractures
xTwo state-of-the-art mediolateral
(ML) locking options enable primary
compression or secondary controlled
dynamization
End caps
xGold end caps securely lock the most
proximal oblique locking screw to
create a fixed-angle construct
xGray end caps feature a lead-in
design for easier end cap insertion
xEnd caps prevent ingrowth of tissue
and facilitates nail extraction
xSelf-retaining T40 StarDrive recess for
easy pick up and insertion of end cap
xCannulated
x0 mm end caps sit flush with nail
x5, 10, and 15 mm end caps extend
nail height if nail is overinserted
TITANIUM CANNULATED TIBIAL NAIL
EXPERT NAILING SYSTEM
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6
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StarDrive
T40
15 mm 10 mm 5 mm 0 mm
15 mm 10 mm 5 mm 0 mm

Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma 3
Advanced nail design
xAnatomic bend for ease of nail
insertion
xTitanium alloy* for improved
mechanical and fatigue properties
xCannulated nails (from 8 mm–13 mm
diameter) for reamed or unreamed
techniques, enabling nail insertion
over guide wire
xAll DePuy Synthes 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)
Advanced distal locking options
xDistal oblique locking options to
prevent soft tissue damage and
increase stability of the distal
fragment
xTwo ML and one anteroposterior
(AP) locking options for stability
of the distal fragment
All locking screws
xDouble-lead thread for more contact
points enhance stability and ease
of insertion
xThread closer to screw head provides
better bone purchase in the near
cortex and improved stability
xTitanium alloy* for improved
mechanical and fatigue properties
xSelf-tapping blunt tip
xSelf-retaining T25 StarDrive recess
allows improved torque transmission
and increased resistance to stripping
relative to a hex recess and secure
locking screw pick-up
Dual-core locking screws
xIndicated for the three proximal
locking options of all tibial nails
xDual-core design for optimized
purchase in cancellous bone
xUnicortical
xLengths: 30 mm–90 mm
Standard locking screws
xLarger cross-section for improved
mechanical resistance
x4.0 mm diameter for 8 mm and 9 mm
tibial nails, lengths: 18 mm–80 mm
x5.0 mm diameter for 10 mm–13 mm
tibial nails, lengths: 26 mm–100 mm
Titanium Cannulated Tibial Nail
Expert Nailing System
MULTIDIRECTIONAL LOCKING OPTIONS FOR IMPROVED STABILITY
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StarDrive
T25
*Titanium-6% aluminum-7% niobium alloy

4 DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique
AO PRINCIPLES
1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal
Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991.
In 1958, the AO formulated four 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 fixation or splintage, as the personality
of the fracture and the injury requires.
Preservation of blood supply
Preservation of blood supply to soft tissue and bone
by careful handling.
Early, active mobilization
Early, active mobilization of the part and patient.

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.

6 DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique
CLINICAL CASES
Shaft fracture
Case 1
For simple shaft fractures, two proximal ML and two distal
ML locking screws are normally sufficient to stabilize the
fracture. Secondary 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 stabilization of the distal fragment. In many cases,
three locking screws placed in the most distal locking options
are sufficient to stabilize the distal fragment.
Note: Results from clinical cases are not predictive of results in other cases.
Results in other cases may vary.

Titanium Cannulated 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
Intraoperative

8 DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique
PREOPERATIVE PLANNING
Use the AO preoperative planner template for the Tibial
Nail–EX to estimate nail diameter and nail length. To estimate
nail diameter, place the template on the AP or lateral x-ray
of the uninjured tibia and measure the diameter 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 on patient anatomy. When selecting nail size, consider
canal diameter, fracture pattern, patient anatomy, and post-
operative protocol.
Note: Templates are available in two sizes: actual size
and 115% magnification in which the image is enlarged
15% to correspond to typical radiographic magnification;
however, variations in magnification levels are common.

Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma 9
2
Reduce fracture
Instrument
394.35* Large Distractor
Perform closed reduction manually by axial traction under
image intensification. The use of the large distractor may
be appropriate in certain circumstances.
Note: The reduction can be temporarily fixed with reduc-
tion clamps. In epiphyseal fractures the condyles or the
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 flexed at least 90°.
Position the image intensifier so that visualization 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 roll can be placed under the lower part
of the thigh if it obstructs the view of the tibial plateau
in the AP view.
*Also available