Insert the guide wire for approximately 8 cm10 cm and check the position under image intensification in the ap and lateral views. In recent years biological surgical solutions have been recommended in cases of distal tibial fractures, with the aim of reducing damage to soft tissues and to bone vascular supply. Author links open overlay panel laura ramos a maria luisa bertrand b. The fractures were classified, following the gustilo system as grade i7, grade ii7 and grade iii10. Utilizing unreamed interlocking nail for open tibial fractures is a good method of treatment particularly those of grade ii, and iiia. Reamed and unreamed intramedullary nailing for the. Between the years 19911995, 52 patients suffering from fractures of the distal tibial metaphysis were treated in our department with an unreamed tibial nail utn. Use of unreamed nailing in those typeiii fractures with delayed presentation was not recommended, because of high incidence of complications. Used synthes titanium unreamed femoral nail specialty locking. This work and the related pdf file are licensed under a creative commons attribution 4. Synthes tibial nail wrap holds 11 nails and synthes intramedullary nail wrap holds 10 nails. Tibial nail ex suprapatellar approach surgical technique guide. All the patients were seen initially at the central emergency service and, after assessment and release by the specialty teams, were referred to the department of orthopedics and traumatology for the fractures to be treated.
This paper reports early experiences with the immediate use of the ao unreamed tibial nail, the immediate complications and the 14 months followup of patients with gustilo grades i, ii and iiia open tibial fractures. Titaniumtibial nail insertionlocking part number description quantity tibial nail accessory implant tray holding sleeve screwdriver flute drill 3flute drill screw forceps 11mm combination wrench slotted hammer guide wire cannulated 11mm thandle socket wrench driving head protective sleeve drill sleeve trocar inserterextractor insertion handle with tibial nail aiming insertion bolt solid. We compared a prospective series of thirtyone patients managed with a solid nail with static interlocking without intramedullary reaming, with a retrospective series of. Recently introduced tibial intramedullary nails allow a number of distal screws to be used to reduce the incidence of malalignment and loss of fixation of distal metaphyseal fractures. Previous small trials have left the evidence for either approach inconclusive. Unreamed intramedullary nailing in distal tibial fractures. Unreamed intramedullary nailing of femoral fractures in the elderly. Between april 1991 and december 2002, 160 diaphyseal tibial fractures in 158 skeletally mature patients were treated using the ao unreamed tibial nail utn, synthes gmbh, umkirch, germany by experienced trauma specialists in a level i trauma centre. Analysis of delayed fracture healing following unreamed. Physealsparing unreamed locked intramedullary nailing for adolescent tibial fractures.
The distal segment can be stabilized by using the two ml locking options of the tibial nailex. Expert tibial nail surgical technique depuy synthes 11 3 confirm nail length and diameter instrument 03. Overall fracture healing time was 23 weeks in the reamed group and 25 weeks in the unreamed group. The aoasif unreamed femoral nail ufn the basics synthes bulletin no. Over all morbidity is reduced and better patient satisfaction noted. Physealsparing unreamed locked intramedullary nailing for. Pdf a multicentre case series of tibia fractures treated. Up to thirty percent of all unreamed nail locking screws can break after initial weight bearing is allowed at 810 weeks if union has not occurred. In literature filardi 11 obtained a value of 160 mpa, on the nail body of an expert tibial nail depuy synthes. Extending the indications of intramedullary nailing with. Automated fit quantification of tibial nail designs during. Pdf reamed versus unreamed nail in the treatment of tibia. The unreamed tibial nail in the treatment of distal.
Pdf distal locking screws for intramedullary nailing of. Introduction open tibial fractures are challenging fractures to treat. Synthes 1 ufncfn unreamed cannulated femoral nail table of contents warning this description is not sufficient for immediate application of the instrumentation. Pdf intramedullary nailing without interlocking screws for femoral. Dec 12, 2015 intramedullary nail fixation remains the treatment of choice for unstable and displaced tibial shaft fractures in the adult. Extending the indications of intramedullary nailing with the. This site is published by the depuy synthes companies, which are solely responsible for its content. A manual drill then enlarged the hole through the near cortex and up to the nail. Pdf extending the indications of intramedullary nailing with the. Because of its anatomical crosssection, the utn is more. Browse our unreamed tibial nails catalogue online and request a free quote now. 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.
The goals of surgical treatment are to achieve osseous union and to restore length, alignment, and rotation of the fractured tibia. The titanium cannulated tibial nail system has not been evaluated for safety and compatibility. Unreamed interlocking nailing in open fractures of tibia. Twentyfive mainly recreational soccer players who sustained a tibial shaft fracture were treated with the aoutn unreamed tibial nail. Solid and cannulated nails technique guide synthes synthes on. Unreamed interlocking tibial nailing can be safely used for typei and typeii open injuries even with delayed presentation. Journal of orthopaedic surgery and research biomed central.
Image intensifier control indications for femoral nailing 2 indications for ufncfn 6. Position the carm for an ap view of the distal tibia. Technique tip for the removal of a nonremovable tibial nail expert tibial nail f. This site is for visitors from europe, middle east and africa. Expert tibia nail depuy synthes pdf catalogs technical. During a oneyear period starting january 1991, 17 tibial shaft fractures have been treated with the new ao unreamed tibial nail in a prospective study. A biomechanical comparison of the current rtn prototype against antegrade nailing expert tibial nail. This biomechanical study was performed to address this question. Six eligible randomised controlled trials were included. Comparison of outcome in reamed vs unreamed nailing in the treatment of tibial diaphyseal fracture 536 p j m h s vol. Distal oblique locking option to prevent soft tissue damage and. To assess the outcome of tibial shaft fractures treated with the ao.
Ut n ctn solidcannulated tibial nail indications for tibial nailing 1 the number of different implants available for intramedullary fixation of the tibia has grown over the years. This is a prospective study based on 30 cases of compound tibial diaphyseal fractures fulfilling our inclusion criteria and stabilised with primary unreamed solid ao tibial locked nailing with a follow up ranging. Trigen meta nail tibial nail system surgical technique. 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. Titanium cannulated tibial nailex with proximal bend j. Its application in distal tibial fractures, however, remains controversial. Pdf the ao unreamed tibial nail utn has been used for both open and closed tibial fractures. Distal oblique locking option to prevent soft tissue damage and increase. Between january 2007 and october 2017, unreamed locked solid intramedullary nailing was used in 16 cases of adolescent mean age. Pdf unreamed intramedullary locking nailing for open. Class 2 device recall synthes tibial nail wrap holds 11 nails. The tibial nail ex with proximal bend 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.
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. Cannulated nails 8 mm to mm diameters for reamed or unreamed techniques, enabling nail insertion over guide wire. Differences in rate of clinical union, clinical outcome, time. Intramedullary nailing in distal tibial fracture is controversial because of a lack of stability. It is cost effective with short hospital stay and facilitates earlier return to work. Their articular cartilage layers, were simulated by 3d membranes of opportune stiffness connecting the different segments. There were 103 patients with 104 tsf enrolled in the study within the period from december 2005 to june 2010. Mar 31, 2016 distal locking screws for intramedullary nailing of tibial fractures. The expert tibial nail etn is standard in treating tibial fractures with a wide range of indications.
Synthes titanium unreamed femoral nail specialty locking set free. The purpose of this study was to investigate the clinical efficacy of reamed versus unreamed intramedullary nailing for open tibial fractures otf. Apr 16, 2009 premature failure of either the nail andor locking screws with unstable fracture patterns may lead to angulation, shortening, malunion, and im nail migration. Comparison of outcome in reamed vs unreamed nailing in the.
Distally, the expert tibial nail can be locked with two ml locking screws see. This site is published by the depuy synthes companies, which are. Distal locking screws for intramedullary nailing of tibial. Volume 45, supplement 1, january 2014, pages s81s86. Download pdf titanium locking screws and bolts for im nails inventory control form. Healing of tibial comminuted fractures by the meaning of. Suprapatellar instrumentation for expert tibial nail. The primary problem this presents is hardware removal during revision surgery. Surgical technique continued unreamed technique radiographic templating is used to determine nail size. Depuy synthes suprapatellar instrumentation for titanium cannulated tibial nails surgical technique. Synthes urtn unreamed tibial nail insertion and titanium. Unreamed nailing has gained acceptance in the treatment of diaphyseal long bone fractures, especially in cases with polytrauma or highenergy injuries.
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 guide carefully before use. Recently, suprapatellar nailing in the semiextended position has been suggested as a safe and effective surgical technique. The implants differ in their design slottedunslotted, solidcannulated, small diamete. Get your kindle here, or download a free kindle reading app. Unreamed solid locked nailing in the treatment of compound. Suprapatellar instrumentation for expert tibial nail surgical technique depuy synthes 5 indications and contraindications 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. Instructions for use intramedullary nailing implants. Surgical management of compound fracture tibia using an. Unreamed solid locked nailing in the treatment of compound diaphyseal fractures of tibia. Advance that nail which will most effectively pull the proximal fragment into alignment. Synthes titanium tibial nail insertion and locking set 105. Not limiting the approach to a certain nailing technique. Titanium cannulated tibial nail expert nailing system. The healing stages of an intramedullary implanted tibia.
Pdf tibial shaft fractures treated with the ao unreamed. Pdf unreamed intramedullary locking nailing for open tibial. Comparison of outcome in reamed versus unreamed nailing in the treatment of tibial diaphysial fracture muhammad nasir ali,1 abdul munaf saud,2 zulfiqar ali,1 muhammad rafiq sabir1 background. Utnctn solidcannulated tibial nail surgical technique depuy synthes 1 oconoscnrni aa ttscindi ati indi the solid tibial nail utn and cannulated tibial nail ctn are used for the. There remains a compelling biological rationale for both reamed and unreamed intramedullary nailing for the treatment of tibial shaft fractures. The fatigue strength of small diameter tibial nails. Solid nails from 8 mm to 10 mm for unreamed technique advanced distal locking options. The nail insertion technique was found to be clear and quickly acquired by the surgeons unfamiliar with it. Establishing an appropriate starting point is a crucial part of the surgical procedure. The unreamed tibial nail in the treatment of distal metaphyseal.
Metaanalysis of reamed versus unreamed intramedullary. The choice between reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures is an ongoing controversy. A multicentre case series of tibia fractures treated with the expert tibia nail etn. Case history our patient, a 20 years old female, sustained a tibial midshaft. Pdf unreamed interlocking nailing in open fractures of tibia. 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. Open fracture tibia treated by unreamed interlocking nail.
Pdf unreamed nailing of tibial fractures with the solid. Randomized trial of reamed and unreamed intramedullary. Unreamed intramedullary locking nailing for open tibial fractures. Unreamed tibial nails manufacturing company from india. Numerous reduction techiques are available to achieve an anatomic. Synthes urtn unreamed tibial nail insertion and titanium locking set 105. The unreamed tibia nail, langenbecks archives of surgery. Factors of injury severity, course of surgery and hospitalization, and incidence.
However, the number of screws and the type of screw configuration to be used remains obscure. Pdf numerous modifications in nail and screw design have led to the development of the expert tibial nail. The curved proximal nail end determines the angle of insertion for the guide wire. We export and supply high quality unreamed tibial nails at best price. 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. Pdf reamed versus unreamed nail in the treatment of. Gumpert, tanzer karin department of traumatology, medical university graz, auenbruggerplatz 7 a, a8036 graz, austria 1. Read the unreamed tibial nail in the treatment of distal metaphyseal fractures, injury on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Ufn unreamed femoral nail cfn cannulated femoral nail. Due to our experience with fractures having severely disrupted periosteal blood supply, we. Download fulltext pdf download fulltext pdf outcome analysis of interlocking nailing for tibial shaft fractures article pdf available july 2018 with 74 reads. Instruction by a surgeon experienced in handling this instrumentation is highly recommended.
Fatigue strength of common tibial intramedullary nail distal. The average time to achieve bony union was 22 weeks with a 26% incidence of pseudoarthrosis. Reamed and unreamed intramedullary nailing are often used for treatment of tibial injury. As a first result the proximal tibial nail ptn, synthes was designed and clinical investigation was started in 1999. Presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures. This was a single centre prospective randomized trial of 38 adults with a tibial shaft fracture who were treated with either reamed or unreamed nailing. Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Read the unreamed tibial nail in the treatment of distal metaphyseal fractures, injury on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at. B mm for reamed or unreamed techniques, enabling nail insertion over guide wire the 2. Synthes titanium cannulated tibial nail expert system the tibial nailex 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. Results of angularstable locked intramedullary nails in the.
Aug 23, 2014 open fractures of the tibial diaphysis are usually caused by highenergy trauma and associated with severe bone and soft tissue injury. The t2 tibial nailing system offers the competitive advantages of. Ensure that you are familiar with the appropriate surgical technique. Critical analysis of tibial fracture healing following. Tibial diaphysial fractures are among the notorious fractures as far as management is concerned. Pdf outcome analysis of interlocking nailing for tibial. Lower leg fractures are common and complex injuries in soccer players. How many distal bolts should be used in unreamed intramedullary nailing for diaphyseal tibial fractures. Automated fit quantification of tibial nail designs during the insertion using computer threedimensional modelling jayani p amarathunga, michael a schuetz, prasad kvd yarlagadda, and beat schmutz proceedings of the institution of mechanical engineers, part h. A load of 700 n has been applied at the top of pelvis and a part the feet, at the tip, was rigidly fixed. The distal tibia nail is not cleared for primary ankle arthrodesis in the u. Expert nailing system titanium cannulated tibial nail.
Unreamed intramedullary locking nailing for open tibial. We compared reamed and unreamed intramedullary nailing with regard to the rates of reoperations and complications in patients with tibial shaft fractures. Intramedullary nailing is the standard operative treatment of diaphyseal tibia fractures9 it is also used effectively in treatment of nonunions of the tibial shaft. The titanium cannulated tibial nail ex is available in a universal design for the left or right tibia, with a 10. The femoral recon nail frn system is an integrated nailing system designed to adapt to multiple surgical approaches. The tibial nail ex with proximal bend is intended to stabilize fractures of the proximal and distal tibia and. Pdf initial experiences with the unreamed tibial nail. Unreamed nailing of tibial fractures with the solid tibial nail. Oct 15, 20 the aim of the prospective randomized study was to compare the results of the treatment of tibia shaft fractures tsf by reamed or unreamed intramedullar nail. This study was performed to evaluate the fatigue strength of commonly used small diameter tibial nails. Unreamed intramedullary nailing is an alternative to external fixation in the treatment of open tibial fractures. To assess the clinical outcome of unreamed intramedullary interlocking nailing in open fractures of tibia, and to evaluate the incidence of complications in these open. This prospective series included 25 males with a mean age of 28.