Micromotion at the fracture site after tibial nailing with four unreamed smalldiameter nails a biomechanical study using a distal tibia fracture model j trauma. All surgical techniques are available as pdf files a. Intramedullary nailing of tibial shaft fractures distal to. Tibial nail ex surgical technique guide ota online.
Pdf primary unreamed intramedullary nailing for open. December 26, 2018 elizabeth jacobs regulatory affairs project. The metal tip of the ruler denotes the driving end of the meta nail tibial nail. The titanium nail system includes femoral and tibial nails and screws. Delivered 62k units 20% of all im nail procedures was growthoriented 4. From 0491 to 0696 sixtynine open fractures of the tibia were primarily treated on the day of the accident with unreamed nailing utn, synthes. There was a delay in full patient mobilization and in the progression. Micromotion at the fracture site after tibial nailing with. Preoperative estimation of tibial nail lengthbecause size does. The expert tibial nail with protect coating releases high concentrations of antibiotics into the implants surroundings to protect your patients from bacterial colonization of the implant. The tibial nail ex provides secure fixation which permits controlled, early, active rehabilitation conducive to optimal recovery. A series of 23 patients with tibial shaft fractures, 12 open and 11 closed, were treated using a utn unreamed tibial nail technique. Clinical results of the primary fixation of open tibial.
More secondary procedures were needed to obtain union after unreamed nail insertion for the treatment of closed tibia fractures, but the difference was not statistically significant given the. Pdf unreamed intramedullary locking nailing for open. The trigen meta nail tibial nail is indicated for fractures of the proximal and distal third of the tibia, including the shaft, stable and unstable factures, nonunions, malunions and for the prophylactic nailing of impending pathological factures. Learn the distal tibial fracture managed with fixator assisted synthes expert tibial nail with suprapatella nail approach and blocking screw surgical technique with step by step instructions on orthoracle. Selecting the correct tibial nail length is essential for satisfactory outcomes. Pdf extending the indications of intramedullary nailing with the. The short rtn implant leaves most of the medullary canal, and especially the isthmus uninvolved, which minimized the risk of fat emboli. The nail was 9 mm in diameter in 16 cases and 8 mm in 7 cases. Expert tibial nail etn available with protect coating the expert tibial nail etn is standard in treating tibial fractures with a wide range of indications. Figure 1 from extending the indications of intramedullary. The expert tibial nail etn is standard in treating tibial fractures with a wide range of indications. Jan 2005 zzlmmucr 4 1 20u5 traditional 510k premarket. In the events of malunion or nonunion pseudoarthrosis tumor resection features definition of the nail design solid cannulated round unreamed reamed wedge formed distal end titanium flexibility and biocompatibility 4. The unreamed tibial nail in the treatment of distal.
Ufn unreamed femoral nail cfn cannulated femoral nail synthes. Development of the expert tibial nail due to the technical limitations of the available implants such as the unreamed tibial nail utn, synthes for the stabilization of metaphyseal fractures, new intramedullary tibial implants have been developed. Fatigue load of current tibial intramedullary nail designs. All 9 were locked statically and dynamization was done late, at an average of 4. In the unreamed nailing group, the surgeon inserted the nail, without reaming, across the fracture site, with particular. The nail has multiple screw holes in the proximal body to allow surgeons to address different fracture types. Pdf unreamed nailing of tibial fractures with the solid. Unreamed tibial nail, manufactured by synthes, k932330, cleared 03081996 lateral entry femoral nail system by synthes, k040336, cleared 04122004 osteo ic retrogradeantegrade femoral nail. Instructions for use intramedullary nailing implants. Feb 01, 1999 the unique characteristics of the ao unreamed tibial nail synthes ag, switzerland have led us to treat distal tibial fractures with no massive joint involvement by means of a combination of unreamed nailing of the metaphyseal portion and percutaneous internal fixation of the articular surface. Screws are placed through the nail to secure the implant in place and maintain length and alignment while healing occurs. Synthes expert tibial nail surgical technique 1 aoasif principles of internal. Position the carm for an ap view of the distal tibia.
Titanium cannulated tibial nail surgical technique depuy synthes 1. As a first result the proximal tibial nail ptn, synthes was designed and clinical. The unreamed femur nail ufn, synthes bv, zeist, the netherlands was used for all femoral fractures 9 millimeter. Aug 24, 2018 controversy exists over whether the use of external fixation ef or unreamed tibial intramedullary nailing utn is optimal for the treatment of open tibial fractures. Cannulated nails 8 mm to mm diameters for reamed or unreamed techniques, enabling nail insertion over guide wire all depuy synthes 2. An intramedullary stabilisation with an unreamed tibial nail utn was carried out in 75 patients suffering from first n 45 and second n 30 degree open fractures. Expert nailing system titanium cannulated tibial nail. The distributions of fracture type according to the ao classification and of soft tissue injury according to gustilo were as follows. Steel locked, unreamed application utn solid tibial nail, titanium alloy tan locked, unreamed application. Pdf radiationfree insertion of distal interlocking.
May, 2014 background currently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis mipo represent the main surgical alternatives in distal tibial fractures. Confirm guide rod position in the window at the opposite end of the ruler as shown in order to ensure accurate implant measurement. Utnctn solidcannulated tibial nail surgical technique depuy synthes. Intramedullary nailing without interlocking screws for femoral and. Utnctn solidcannulated tibial nail surgical technique depuy synthes 1. Free access of the nail to the insertion point must be guaranteed. Distal tibial fracture managed with fixator assisted. The results showed lower risks of tibial fracture nonunion and implant failures with reamed nails compared to unreamed nails in closed tibial fractures relative risk rr. Depuy synthes ti6al7nb unreamed femoral nail mr conditional 20.
Article information, pdf download for intramedullary nailing. Titanium cannulated tibial nail surgical technique depuy synthes 3 advanced nail design x anatomic bend for ease of nail insertion x titanium alloy for improved mechanical and fatigue properties x cannulated nails from 8 mm mm diameter for reamed or unreamed techniques, enabling nail insertion over guide wire. Associated injuries were present in 18 of the 24 patients 75% with. Titaniumstainless steel elastic nail system ufn unreamed femoral nail cfn cannulated femoral nail uhnphn humeral nailing system utnctn solidcannulated tibial nail please read these instructions for use, the synthes brochure important information carefully before use. The other 5 had an 8 mm nail, 2 were unreamed and 3 were reamed. Aa medical store improves healthcare around the world by supplying refurbished stateof theart surgical devices at the best price, with the best warranty, and unmatched service and support. Tin tibia intramedullary locking nail patented tst.
Our elearning platform contains high resolution images and a certified cme of the distal tibial fracture managed with fixator assisted synthes expert tibial nail with suprapatella nail. To estimate nail diameter, place the template on the ap or lateral xray of the uninjured tibia and measure the diameter of the. Pdf unreamed interlocking nailing in open fractures of tibia. The ins hilden tibial arzzt is a single use system that consist the following components. Solid nails from 8 mm to 10 mm for unreamed technique advanced distal locking options. Aug 23, 2014 background open fractures of the tibial diaphysis are usually caused by highenergy trauma and associated with severe bone and soft tissue injury. Extending the indications of intramedullary nailing with the. The standard of care for fixation of midshaft tibial shinbone fractures is intramedullary nailing. Michael schuller, patrick weninger, elmar tschegg, michael jamek, heinz redl, stefanie stanzltschegg journal of trauma 2009, 66 5. However, the use of an unreamed, solid nail combined with interlocking also allows stabilization of open and complex fractures. However, neither choice is optimal for all bony and soft tissue injuries. Synthes solutions the expert tibial nail protect, including its cannulation, is coated with a thin layer approximately 50. So far, the only coated product for intramedullary nailing on the market is t. While today s experience with intramedullar y fixation for tibial and femur fractures has.
Distal locking screws for intramedullary nailing of tibial. Ensure that you are familiar with the appropriate surgical technique. The average time of insertion of both distal interlocking screws was. Fixation of a diaphyseal femoral fracture with a depuy.
Ufn unreamed femoral nail cfn cannulated femoral nail. The universal nail system titaniumstainless steel elastic nail system ufn unreamed femoral nail cfn cannulated femoral nail uhnphn humeral nailing system utnctn solidcannulated tibial nail please read these instructions for use, the synthes important information and the corresponding surgical technique carefully before use. The purpose of this study was to investigate the clinical efficacy of reamed versus unreamed intramedullary nailing for open tibial fractures otf. New anatomic bend for ease of nail insertion titanium alloy tan for improved mechanical and fatigue properties cannulated nails from 8 mm to mm for reamed or unreamed techniques, enabling nail insertion over guide wire the 2. Synthes expert tibial nail technique manual pdf download. All surgical techniques are available as pdf files at. External fixation versus unreamed tibial intramedullary. Development and initial clinical use of an aiming device. Unreamed interlocking nailing in open fractures of tibia. Depuy synthes universal tibial nail and the depuy synthes unreamed tibial nail mr conditional 19. Distally, the expert tibial nail can be locked with two ml locking screws see. Adjust the thumbwheel connection at the end to allow for free movement. The retrograde tibial nail rtn is a smallcaliber prototype implant, which is introduced through a 2cmlong incision at the tip of the medial. Comparison of unreamed nailing and external fixation of tibial.
The ao unreamed tibial nail was the primary device used in all cases. Sirus intramedullary nail classification name intramedullary fixation rod and reference. Sirus intramedullary tibia nail system surgical technique. They did however find that the im nail with the shorter working length distal to the fracture showed a strong relationship with nonunion. Five of the femoral fractures 19% and 14 of the tibial fractures 54% were open. Used synthes titanium femoral nail standard instrument set. Reamed and unreamed intramedullary nailing are often used for treatment of tibial injury. Comminuted tibial shaft fractures are traditionally treated with statically locked intramedullary nailing and protected weight bearing until fracture callous is evident. Pdf unreamed intramedullary locking nailing for open tibial. Fibular fixation as an adjuvant to tibial intramedullary nailing in the. University medicine berlin, free and humboldt university of berlin. Page 71 radiographic ruler for tibial nail, length 450 mm 357. Micromotion at the fracture site after tibial nailing with four unreamed smalldiameter nails a biomechanical study using a distal tibia fracture model. Extending the indications of intramedullary nailing with the expert tibial nail.
The unreamed femoral and tibial naildesign and insertion. To estimate nail diameter, place the template on the ap or lateral xray of the uninjured tibia and measure the diameter of the medullary canal at the narrowest part that will contain. The present experimental study, which was performed on cadaver bones is based on the measurement of the intramedullary pressure exercised by solid titanium nails of different profiles and diameters inserted in. Expert tibial nail surgical technique depuy synthes 11 3 confirm nail length and diameter instrument 03. The purpose of this study was to demonstrate that a simulation of immediate full weight bearing following intramedullary nailing of these fractures does not result in implant failure. Synthes titanium unreamed tibial nails set aa medical store. Thirteen tibial fractures were stabilized with an unreamed tibia nail utn, synthes bv, zeist, the netherlands o 8 mm. Thirteen tibial fractures were stabilized with an unreamed tibia nail utn, synthes bv, zeist, the netherlands, 8 millimeter.
These included type a fractures, 11 type b fractures and five type c injuries. December 26, 2018 elizabeth jacobs regulatory affairs. Note this technique deals with the joint space around the knee. Cannulated nails 8 mm to mm diameters for reamed or unreamed techniques, enabling nail insertion over guide wire. The tibial nail is designed to help treat various fractures of the tibia. Randomized trial of reamed and unreamed intramedullary. Metaanalysis of reamed versus unreamed intramedullary.
This is a reportable malfunction report for synthes solid, titanium unreamed tibial nail referenced in larsen publication. Synthes usa universal tibial nail and unreamed tibial nail k914453 synthes usa ti r6al r7nb urtn k932330 11. Information concerning the injuries, treatments, and much of the followup was gleaned from a trauma registry. Followingtheappearanceofcorticalchatter,thesurgeonreamed 1 to 1. Accessories to depuy synthes titanium alloy unreamed femoral nail urfn mr conditional 22. Extending the indications of intramedullary nailing with.
A 7mm gap osteotomy was performed 72 mm from the tibial plafond to simulate a 42c3 unstable distal tibial fracture. The aiming system was tested in 20 cases in a videodocumented prospective study using the unreamed tibial nail utn, synthes between july 1993 and march 1995. Solid tibial nail, titanium alloy tanlocked, unreamed application same. This copolymer is formed by combining llactide and glycolide, which maximizes the advantageous characteristics of each component and provides a material wellsuited for craniofacial reconstruction figure 1. The coating is abrasion resistant and will withstand most of the forces occurring during nail insertion. Jan 29, 2016 thirtysix expert tibial nails synthes, oberdorf, switzerland were introduced in composite bone models. Suprapatellar instrumentation for expert tibial nail. The models were divided into 4 groups with different distal locking configurations ranging from 2 to 4 screws. Ut nctn solidcannulated tibial nail indications for tibial nailing increase in weightbearing if pain free or evidence of callus formation, at the latest after 6 weeks increasing to full weightbearing if pain free if evidence of callus formation, not before 12 weeks if pain free increasing to full weightbearing if pain free and. Expert tibia nail depuy synthes pdf catalogs technical. The insertion of locking nails into the medullary cavity without previous reaming of the latter has come to meet most prerequisites desirable for biological osteosynthesis. Twentynine tibial shaft fractures were stabilized with the ao unreamed tibial nail.
Although some progress has been made in nail design in the 1990s, significant developments have came along with the expansion of indications for unreamed and reamed intramedullar y nailing. Without compensation for this deformation, it is impossible. Distal oblique locking option to prevent soft tissue damage and. Jan 01, 2014 the main emboli occur in reamed nailing during the first two reaming steps and in unreamed nailing during nail insertion and when the nail is advanced through the tibial shaft. Xxx utnsolid tibial nail, complete, with end cap, stainless steel485. Our series suggests that this is an easy device to insert and that its multiple locking options confer an advantage for the management of distal fractures. Depuy synthes ti6al7nb unreamed tibial nail urtn mr conditional 21. Ufncfn unreamed cannulated femoral nail indications for ufncfn locking the nail must be inserted carefully so as to limit the distraction on the fractured side healing promotion. Orthopaedic implant design from concept to commercialization.
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