Synthes Expert Tibial Nail User manual

Expert
Nailing System
Expert Tibial Nail.
Technique Guide
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Synthes 1
Table of Contents
Image intensifier control
Introduction
Surgical technique
Product information
Features 2
AO/ASIF Principles of internal fixation 4
Indications 5
Cases 6
Preoperative planning 8
Opening the tibia 9
Insert the nail 20
Distal locking 28
Proximal locking 35
Insert the end cap 55
Weight-bearing 57
Implant removal 58
Implant specifications 61
Implants 62
Instruments 69
Warning
This description is not sufficient for immediate application of
the instrumentation. Instruction by a surgeon experienced in
handling this instrumentation is highly recommended.
Cleaning of instruments:
For detailed information please refer to “Reprocessing,
Care and Maintenance of Synthes Instruments”,
Article No. 035.000.090.
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Stardrive
®
T40
2Synthes Expert Tibial Nail
Improved stability
Expert Tibial Nail
Advanced solutions
End caps:
– Securely lock the most proximal
oblique locking screw to create a
fixed-angle construct
– End cap prevents ingrowth of tissue
and facilitates nail extraction
– 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 inserted.
Advanced proximal locking options:
– Three unique and innovative locking
options, in combination with cancel-
lous 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
0 mm 5 mm 10 mm 15 mm
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Stardrive
®
T25
Multidirectional locking options for improved stability
Synthes 3
Advanced nail design:
– New anatomic bend for ease of nail
insertion
– Titanium alloy TAN* for improved
mechanical and fatigue properties
– Cannulated nails (from 8 mm to
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 assem-
bly (no exchange tube required).
– Solid nails (from 8 mm to
10 mm) for unreamed technique
Advanced distal locking options:
– Distal oblique locking option to pre-
vent soft tissue damage and increase
stability of the distal fragment
– Two ML and one antero-posterior
(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 provid-
ing better bone purchase in the near
cortex and improved stability
– Titanium alloy TAN* for improved
mechanical and fatigue properties
– Self-tapping blunt tip
– Self-retaining Stardrive T25 recess
allows improved torque transmission
and increased resistance to stripping
relative to a hex recess and secure
locking screw pick-up.
Cancellous bone locking screws:
– Indicated for the three unique proxi-
mal locking options of all tibial nails
diameters
– Dual core design for optimized pur-
chase in cancellous bone
– Unicortical
– Lengths: 30 mm – 90 mm
Standard locking screws:
– Larger cross section for improved
mechanical resistance
–4.0 mm for 8 mm and 9 mm
tibial nails, lengths: 18 mm – 80 mm
–5.0 mm for 10 mm to
13 mm tibial nails,
lengths: 26 mm – 100 mm
* Titanium-6% aluminum-7% niobium
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4Synthes Expert Tibial Nail
AO/ASIF Principles of
internal fixation
1M.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 principles1, which have
become the guidelines for internal fixation in general, and in-
tramedullary 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, 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.
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Synthes 5
Indications
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:
– 41-A2/A3
– All shaft fractures
– 43-A1/A2/A3
– Combinations 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 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.
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6Synthes Expert Tibial Nail
Cases
Fracture involving the proximal component
Case 1
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
hole.
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
the proximal static locking screw.
Fracture involving the distal component
Case 3
The use of four distal locking screws is sometimes necessary
to achieve stabilization of the distal fragment. In many
cases though, three locking screws placed in the most distal
locking options are sufficient to stabilize the distal fragment.
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Synthes 7
postoperative follow-up (3 weeks after surgery)
preoperative postoperative follow-up (1 month after surgery)
preoperative postoperative follow-up (4 months after surgery)
preoperative
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EXPERTTM Tibial Nail
For use only with the Original AO/ASIF System of
Instruments and Implants
0 10 20 30 40 50 60 70 80 90 100 mm
1.10 Magnification
034.000.015 © Stratec Medical 2005 Printed in Switzerland SEK Subject to modifications.
for Ø 8, 9, 10, 11, 12, 13 mm nails
04.004.003
04.004.002
04.004.001
255 mm
270 mm
285 mm
300 mm
315 mm
330 mm
345 mm
360 mm
375 mm
390 mm
405 mm
420 mm
435 mm
450 mm
465 mm
dynamic
static
0 mm
5
13
22
37
151050mm
Ø 8
AP View Lateral View
Cancellous Bone Locking Screw Ø 5.0 mm (golden) 04.015.5XX
0 mm 30 40 50 60 70 80 90
Locking Screw Ø 5.0 mm (light green) 04.005.5XX
0 mm 26 30 40 50 60 80 10070
Locking Screw Ø 4.0 mm (dark blue) 04.005.4XX
0 mm 18 30 40 50 60 70 80
04.004.000
(04.004.004)
7 mm
Ø 9 mm
Ø 10 mm
Ø 11 mm
Ø 12 mm
Ø 13 mm
Manufacturer: Stratec Medical
Eimattstrasse 3
CH-4436 Oberdorf
www.synthes.com
8Synthes Expert Tibial Nail
Use the AO ASIF Preoperative Planner Template for the
Expert Tibial Nail 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.
Preoperative planning
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