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Johnson & Johnson DePuy Synthes TRAUMA Titanium Cannulated Tibial Nail Surgical Technique

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tItanIum
cannulated
tIbIal naIl
Expert Nailing System
SurgIcal technIque

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Summary of Contents for Johnson & Johnson DePuy Synthes TRAUMA Titanium Cannulated Tibial Nail

  • Page 1 tItanIum cannulated tIbIal naIl Expert Nailing System SurgIcal technIque...

  • Page 2: Table Of Contents

    table of contentS IntroductIon titanium cannulated tibial nail expert nailing System ao Principles Indications clinical cases SurgIcal technIque Preoperative Planning opening the tibia reaming (optional) Inserting the nail locking options locking holes distal locking Proximal locking end cap Insertion Implant removal Product InformatIon Implant Specifications Implants...

  • Page 3: Titanium Cannulated Tibial Nail Expert Nailing System

    0 mm end caps sit flush with nail x 5, 10, and 15 mm end caps extend nail height if nail is overinserted 15 mm 10 mm 5 mm 0 mm StarDrive DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 4 titanium cannulated tibial nail expert nailing System Advanced nail design Advanced distal locking options x anatomic bend for ease of nail x distal oblique locking options to insertion prevent soft tissue damage and x titanium alloy* for improved increase stability of the distal mechanical and fatigue properties fragment x cannulated nails (from 8 mm–13 mm...

  • Page 5: Ao Principles

    Early, active mobilization early, active mobilization of the part and patient. 1. müller me, allgöwer m, Schneider r, Willenegger h. Manual of Internal Fixation, 3rd edition. berlin: Springer-verlag. 1991. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 6: Indications

    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. Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma...

  • Page 7: Clinical Cases

    DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 8 clinical cases Preoperative Intraoperative follow-up (3 weeks after surgery) Preoperative Postoperative follow-up (3 weeks after surgery) Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma...

  • Page 9: Preoperative Planning

    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. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 10: Opening The Tibia

    oPenIng the tIbIa 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.
  • Page 11 7 mm of travel. Important: The ruler is not at the same level as the tibia. This affects the accuracy of the measurement, providing only an estimate of the canal diameter. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 12 opening the tibia Approach make an incision in line with the central axis of the intramedullary canal. depending on the anatomy of the patient, this incision can be transpatellar, medial or even lateral parapatellar. the incision starts proximally at the distal third of the patella along the patellar ligament down to the tibial tuberosity.
  • Page 13 Insert the guide wire for approximately 8 cm – 10 cm and check the position under image intensification in the aP and lateral views. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 14 opening the tibia Open medullary canal Instruments 03.010.035 12.0 mm Protection Sleeve 03.010.036 12.0 mm cannulated drill bit, large quick coupling, 190 mm 357.399 3.2 mm guide Wire, 400 mm Place the protection sleeve and the drill bit over the guide wire and down to the bone.

  • Page 15: Reaming (Optional)

    System can be inserted over the reaming rod with ball tip. Reaming rod exchange is not required. Option use the reaming rod push rod to help retain the reaming rod during reamer extraction. *also available DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 16: Inserting The Nail

    InSertIng the naIl Assemble insertion instruments Instruments 03.010.044 cannulated connecting Screw, for Standard Insertion handle 03.010.045 Standard Insertion handle 03.010.092 ball hex Screwdriver, 8 mm orient the insertion handle anteriorly, and match the tang on the handle to the notch in the nail. Place the connecting screw into the insertion handle and thread it into the proximal nail end, using the 8 mm ball hex screwdriver.
  • Page 17 DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 18 Inserting the nail Note: If nail insertion is difficult, choose a smaller diameter tibial nail or ream the medullary canal to a larger diameter. Important: Confirm that the nail is securely connected to the insertion handle, especially after hammering, using either the 8 mm ball hex screwdriver or the cannulated shaft with 8 mm hex.
  • Page 19 8 mm hex. Note: Insertion depth is critical for distal third fractures where a minimum of two locking screws below the fracture line are required to stabilize the distal segment. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 20: Locking Options

    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.

  • Page 21: Locking Holes

    7 mm Stat 2 Stat 1 ML view 37 mm 22 mm for anterolateral or 13 mm anteromedial locking oblique 5 mm (30° to the sagittal plane) DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 22: Distal Locking

    dIStal lockIng Distal locking Instruments 03.010.017 tibial nail– ex Insertion handle 03.010.145 cannulated connecting Screw 511.30 radiolucent drive use the appropriate locking screws and drill bit for the nail diameter selected. Nail diameter Locking screw Drill bit 8 mm and 9 mm 4.0 mm 3.2 mm (blue)
  • Page 23 (distal ml hole shown in illustration). Determine incision point Place a scalpel blade on the skin over the center of the hole to mark the incision point and make a stab incision. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 24 distal locking Drill Instruments 03.010.100* 3.2 mm three-fluted drill bit, quick coupling, 145 mm, for radiolucent drive 03.010.101* 4.2 mm three-fluted drill bit, quick coupling, 145 mm, for radiolucent drive using the radiolucent drive under image intensification, insert the tip of the appropriate drill bit through the incision and down to the bone.
  • Page 25 Note: Drill bit location with respect to the far cortex is critical for measuring the appropriate locking screw length. * also available DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 26 distal locking Alternative instrument 03.010.072 depth gauge, for locking Screws to 100 mm, for Im nails measure the locking screw length using the depth gauge for locking screws. ensure the outer sleeve is in contact with the bone and the hook grasps the far cortex. read the locking screw length directly from the depth gauge at the back of the outer sleeve.
  • Page 27 * backslap technique: with the hammer guide attached to the driving cap and insertion handle (see page 16) light, reverse hammer blows may be used to compress the fracture; monitor reduction radiographically. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 28: Proximal Locking

    ProxImal lockIng— dIaPhySeal and dIStal Segment fractureS Choose locking screws and instruments use the correct locking screw, drill sleeve, trocar and drill bit for the selected nail diameter, as shown in the table. three proximal ml locking options can be targeted using the aiming arm: 1 the dynamic locking option (dynam) corresponds to the upper position of the proximal locking slot.
  • Page 29 DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 30 Proximal locking— diaphyseal and distal Segment fractures Drill and determine locking screw length Instruments 03.010.060 3.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration (with blue and gold marking) 03.010.061 4.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration (with green marking) ensure that the drill sleeve is pressed firmly to the near cortex.
  • Page 31 34 for details on proximal locking with the dual core locking screws. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 32 ProxImal lockIng— comPreSSIon lockIng mode (oPtIonal) Compression locking mode (optional) for situations where the fracture gap needs compression after nail insertion, this can be accomplished without removing the insertion instruments. the tibial nail– ex allows a maximum compression of 7 mm. If more compression of the fracture gap is needed, the conventional backslap technique is recommended (see page 26).
  • Page 33 –ex, for use with (03.010.145) and (03.010.017) 03.010.137* long compression device for titanium cannulated tibial nails –ex, for use with (03.010.146) and (03.010.046) *also available DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 34 Proximal locking—compression locking mode (optional) Monitor fracture control the fracture gap before, during, and after the compression procedure. Insert static locking screw Insert second proximal locking screw in the most distal hole of the proximal locking options (Static 1). refer to section diaphyseal and distal Segment fractures on pages 27 to 30.
  • Page 35 2 the oblique locking option (dIStal oblIque) corresponds to the second proximal locking position. 3 the oblique locking option in anteroposterior direction (aP) corresponds to the third proximal locking position. *also available DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 36 Important: Drilling for the oblique proximal locking requires special attention. To avoid lesion of the popliteal artery, the tibial nerve and the common peroneal nerve, as well as damage to the proximal tibiofibular joint, drilling must be stopped immediately before penetrating the far cortex. Note: When locking with the leg in full extension, it is recommended to use the Tibial Nail–EX insertion handle...
  • Page 37 Do not exert forces on the aiming arm, protection sleeve, drill sleeves and drill bits. These forces may prevent accurate targeting through the proximal locking holes and damage the drill bits. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 38 Proximal locking — Proximal Segment fractures Insert trocar combination Instruments 03.010.063 12.0 mm /8.0 mm Protection Sleeve, 188 mm 03.010.064 8.0 mm/3.2 mm drill Sleeve, 200 mm (with blue and gold marking) 03.010.069 3.2 mm trocar, 210 mm (with blue and gold marking) Insert the three-part trocar combination (protection sleeve, corresponding drill sleeve and trocar) through the desired hole for oblique locking options in the aiming arm, make...
  • Page 39 Important: To avoid perforation of the far cortex with the dual core locking screw, a dual core locking screw 5 mm shorter than the measured length is recommended. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 40 Proximal locking — Proximal Segment fractures Insert dual core locking screws Instrument 03.010.107 Stardrive Screwdriver, t25, self-retaining Insert the appropriate 5.0 mm dual core locking screw through the protection sleeve, using the t25 Stardrive screwdriver. do not overtighten. verify locking screw length under image intensification. repeat this procedure for the second dual core locking screw.
  • Page 41 DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 42: End Cap Insertion

    end caP InSertIon Insert end cap Instruments 03.010.110 cannulated Stardrive Screwdriver, t40 357.399 3.2 mm guide Wire, 400 mm all titanium end caps for the tibial nail –ex are available in extension lengths of 0 mm, 5 mm, 10 mm, and 15 mm. they prevent bone ingrowth into the nail and they extend the nail height if it is overinserted.
  • Page 43 Stardrive screwdriver. Note: The end cap will engage the most proximal oblique locking screw to create a fixed-angle construct. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 44: Implant Removal

    ImPlant removal Remove end cap and locking screws Instruments 03.010.107 Stardrive Screwdriver, t25, self-retaining 03.010.110 cannulated Stardrive Screwdriver, t40, self-retaining 03.010.112 holding Sleeve, with locking device Implant removal is an optional procedure. clear the Stardrive socket of the end cap and the locking implants of any tissue ingrowth.
  • Page 45 Stardrive screwdriver. Remove nail Instrument 03.010.056 Slide/fixed hammer, 700 grams extract the nail by applying gentle blows with the hammer. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 46 Implant removal Alternative Technique– Extraction Hook For removal of broken nail Instruments 03.010.044 cannulated connection Screw 355.399 extraction hook, for titanium cannulated ◊ nails 357.133 extraction Screw 393.10 universal chuck with t-handle 393.105 Small universal chuck with t-handle clear tissue from the end of the nail and remove the end cap. remove the locking bolts and/or screws with the appropriate screwdriver.
  • Page 47 Note: Keep the patient’s limb restrained to increase the efficiency of the extraction force. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 48 Implant removal For removal of an intact nail Instruments 355.399 extraction hook, for titanium cannulated ◊ nails 393.10 universal chuck with t-handle 393.105 Small universal chuck with t-handle clear tissue from the end of the nail and remove the end cap. remove the locking bolts and/or screws with the appropriate screwdriver.

  • Page 49: Implant Specifications

    8 mm – 10 mm nails are round x 11 mm – 13 mm nails are fluted end of bend is half length of nail 37 mm 22 mm 13 mm 5 mm oblique DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 50: Implants

    ImPlantS Titanium Cannulated Tibial Nails–EX, sterile* length 8 mm dia. 9 mm dia. 10 mm dia. (mm) dark blue dark blue light green 04.004.231S 04.004.331S 04.004.431S 04.004.234S 04.004.334S 04.004.434S 04.004.237S 04.004.337S 04.004.437S 04.004.240S 04.004.340S 04.004.440S 04.004.243S 04.004.343S 04.004.443S 04.004.246S 04.004.346S 04.004.446S 04.004.249S 04.004.349S...
  • Page 51 04.015.557S 04.015.527S 04.015.562S 04.015.532S 04.015.567S 04.015.537S 04.015.572S 04.015.542S 04.015.577S 04.015.547S available nonsterile or sterile-packed. add “S” to catalog number to order sterile product. ◊ *titanium-6% aluminum-7% niobium alloy DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 52 Implants 4.0 mm Titanium Locking Screws , with T25 StarDrive ◊ recess, for IM nails (blue) x titanium alloy* x lengths: 18 mm –80 mm (2 mm increments) x 3.3 mm core diameter x fully threaded x Self-tapping, blunt tip length (mm) length (mm) 04.005.408...
  • Page 53 04.005.538 04.005.570 04.005.540 04.005.575 04.005.542 04.005.580 04.005.544 04.005.585 04.005.546 04.005.590 ◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product. *titanium-6% aluminum-7% niobium alloy DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 54 Implants Titanium Angular Stable Locking Screws, with T25 StarDrive recess, for intramedullary nails, sterile* x titanium alloy** x available lengths 4.0 mm aSlS screw: 26 mm– 80 mm • 5.0 mm aSlS screw: 30 mm– 100 mm • x fully threaded shaft with 3 diameters d1: Provides purchase in reamed near cortex •...
  • Page 55 Titanium Tibial Nail (cannulated) 10 –13 • *must be ordered separately. based on in-vivo animal testing. In-vivo animal testing may not necessarily be indicative of human clinical performance. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 56 Implants Titanium End Caps , with T40 StarDrive recess, ◊ for Titanium Tibial Nails–EX x titanium alloy* x Protect nail threads from tissue ingrowth x cannulated x t40 Stardrive recess 0 mm x Sits flush with end of nail 5 mm, 10 mm and 15 mm extensions x extend nail height if nail is overinserted Titanium End Caps , with T40 StarDrive recess,...

  • Page 57: Instruments

    12.0 mm Protection Sleeve 03.010.036 12.0 mm cannulated drill bit, large quick ◊ coupling, 190 mm ◊ available nonsterile or sterile-packed. add “S” to product number to indicate sterile product. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 58 Instruments 03.010.040 12.0 mm cannulated awl 03.010.044 cannulated connecting Screw, for Standard Insertion handle 03.010.045 Standard Insertion handle 03.010.047 driving cap with handle adapter 03.010.052 aiming arm, for titanium cannulated tibial nails– ex 03.010.056 Slide/fixed hammer, 700 grams Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma...
  • Page 59 4.2 mm trocar, 210 mm 03.010.072 depth gauge, for locking Screws to 100 mm, for Im nails ◊ available nonsterile or sterile-packed. add “S” to product number to indicate sterile product. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 60 Instruments 03.010.092 ball hex Screwdriver, 8 mm 03.010.093 reaming rod Push rod, with ball handle 03.010.103 3.2 mm three-fluted drill bit, ◊ quick coupling, 145 mm 03.010.104 4.2 mm three-fluted drill bit, ◊ quick coupling, 145 mm 03.010.106 direct measuring device, for locking screws to 100 mm, for Im nails 03.010.107 Stardrive Screwdriver, t25, self-retaining...
  • Page 61 Screw, for titanium femoral and tibial nails 357.22 hammer guide, for Slide hammer 357.398 cannulated Shaft with 8 mm hex, 125 mm 357.399 3.2 mm guide Wire, 400 mm DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...

  • Page 62: Set Lists

    tIbIal naIl– ex InStrument Set (01.004.303) Graphic Case 69.004.300 tibial nail –ex Instrument Set graphic case Instruments 03.010.015 compression device, for titanium cannulated tibial nails–ex 03.010.021 radiographic ruler, for titanium cannulated tibial nails 03.010.023 radiographic canal Width estimator, for Im nails 03.010.024 holding device, for guide Wires and reaming rods...
  • Page 63 Shaft with 8 mm hex, 125 mm 357.399 3.2 mm guide Wire, 400 mm, 3 ea. ◊ available nonsterile or sterile-packed. add “S” to product number to indicate sterile product. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 64 tIbIal naIl– ex ImPlant Set (01.004.304) Graphic Case 690.504 locking Screw rack, for tibial nail–ex Implants Instrument 319.97 Screw forceps Implants titanium end caps, with t40 Stardrive recess, for tibial nails– ex (gold) ◊ extension (mm) 04.004.000 04.004.001 04.004.002 04.004.003 titanium end caps, with t40 Stardrive recess, extended tip, for tibial nails–...
  • Page 65 04.005.530 04.005.558 04.005.532 04.005.560 04.005.534 04.005.562 04.005.536 04.005.564 04.005.538 04.005.566 04.005.540 04.005.568 04.005.542 04.005.570 ◊ available nonsterile or sterile-packed. add “S” to product number to indicate sterile product. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 66 tIbIal naIl–ex InStrument and tItanIum ImPlant Set (01.004.300) 01.004.300 consists of: 01.004.303 tibial nail –ex Instrument Set 01.004.304 tibial nail –ex Implant Set Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique DePuy Synthes Trauma...
  • Page 67 04.025.556S 04.025.528S 04.025.558S 04.025.530S 04.025.560S 04.025.532S 04.025.562S 04.025.534S 04.025.564S 04.025.536S 04.025.566S 04.025.538S 04.025.568S 04.025.540S 04.025.570S 04.025.542S 04.025.575S 04.025.544S 04.025.580S 04.025.546S 04.025.585S 04.025.548S 04.025.590S * must be ordered separately. DePuy Synthes Trauma Titanium Cannulated Tibial Nail Expert Nailing System Surgical Technique...
  • Page 68 alSo avaIlable Instruments Power Equipment 03.010.017 tibial nail–ex Insertion handle 511.30 radiolucent drive 03.010.046 Percutaneous Insertion handle 511.73 Jacobs chuck with key (large) 03.010.100 3.2 mm three-fluted drill bit, quick coupling, 511.75 quick coupling for drill bits ◊ 145 mm, for radiolucent drive 511.761 large quick coupling 03.010.101...
  • Page 69 CAUTION: Federal Law restricts these devices to sale by or on the order of a physician. the legal manufacturers for the uS and canada are listed below: Synthes (USA) Synthes (Canada) Ltd. 1302 Wrights lane east 2566 meadowpine boulevard West chester, Pa 19380 mississauga, ontario l5n 6P9 telephone: (610) 719-5000 telephone: (905) 567-0440...

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