Aesculap Targon TX - OSTEOSYNTESE.dk

1 Aesculap OrthopaedicsAesculap Targon TXIntramedullary Nail for Tibial to X-tremesTargon TX 2 Dear colleagues,Today, locking nailing of tibial shaft fractures is regarded as beingthe "gold standard". However, in transition fractures, particularlythose of the proximal moiety, locking nailing has taken a backseatto angle-stable plating because of reports about primary and secon-dary malalignment, although the use of transmedullary supportscrews (poller screws) can keep the rate of precisely this compli-cation very low. And so, already at this level of tibial fractures thebrotherhood of trauma surgeons is already divided into "nailers"and "platers".

2 This disagreement becomes truly evident in type A fractures according to the AO classification. The "hands off the metaphysis"warning of the proponents of plating and external fixation is making the rounds. However, there is an increasing body of evi-dence on rather successful intramedullary nailing of extra-articulartype A fractures and even type C fractures with uncomplicatedinvolvement of the joint. These techniques have relied on newly developed nails with extremely distal as well as proximal lockingoptions which may also be combined with cannulated screws, shouldthe need arise (type C fractures). The appeal of these new nailingtechniques is due to the fact that not only do they result in theleast amount of additional soft tissue trauma, which is particularlyimportant for those areas of concomitant soft tissue injury adjacentto the joint, but they also offer the best postoperative comfort forthe compression is one more attractive benefit of locking stable fractures and transverse osteotomies it permits very earlypainless ambulation under full weight bearing.

3 Interlocking com-pression nailing has also been successful in the treatment of hyper-trophic Targon TX nail was developed for all these indications, andfor the first time this nail is also available as a short model, employedwhenever the proximal tibial fracture lends itself well to intrame-dullary fixation while insertion of a locking nail is contraindicateddue to special circumstances at the distal part of the lower leg. I am confident that compared with conventional locking nails thisnail has opened up previously untapped indications for intra -medullary fixation of tibial Stedtfeld, October 2009 Priv. Doz. Dr. Stedtfeld,Centre for Trauma Surgery,Nuremberg, toX-tremesSystem Advantages Implants4 Proximal Design Multidirectional angle-stable epiphyseal fixation Significantly more versatile treatment options proximally and distally Proximal nail design identical in both shortand long model Easier passage of the nail due to optimizedcurvature Optional transfixation in proximal locking Long Nail For the treatment of rather distal tibial fractures.

4 1 a-p and 2 m-l holes at the end of the nail Effortless introduction and extractionof the nail due to distal curvature of 2 Cannulated nail designShort Nail Proximal fixation with the same high degree of stability if the situation at the distal tibia does not permit locking Threaded bore for guided implant positionwithout canting in wide proximal me-dullary canals Cannulated and solid nail models optional5 Locking ScrewsAbsolutely multidirectional screw blocking(zero motion) The unique position of the proximal screws ensures absolutely angle-stable fixation of the fracture Angle-stable triple locking can be adjusted to different fracture levels (maximum fixation effect)

5 Uniform screw design for all locking optionsCap ScrewOptimum nail position close to the ankle joint Cap screw with length 0 mm 5 mm and 10 mm long extension screws for length adjustment of the 15 mm increments when the long nail is seated more deeplyMinimum soft tissue trauma Bevelled design Extension screws identical with proximal end of nailSystem Advantages Instruments6 Targeting DeviceLocking of all short nail screws via the targeting device Completely angle-stable locking for maximum stability Easier handling when positioning the distal screws No more slipping of the nail over the locking screwsSnap-fit attachment Rapid and safe system attachments Targeting device + guide wire Reliable position assessment of the proximal screwBase of targeting device Unrestricted extension of the knee joint after complete insertion of the nail into the medullary canal7 InstrumentsProximal sliding hole for com -pression and dynamic fixation Flexible fracture treatment for individual solutions Color-coded ergonomic instruments Intuitive orientation when handling the instrumentsPolygon-shaped sleeves Easy and rapid sleeve retention The polygon-shaped sleeve is securely jammed in the targeting device by slight twisting8 The ImplantTX Nail (General)

6 Technical characteristics Proximal diameter: 11 . 5 m m Distal diameter: 8 mm, 9 mm, 10 mm Proximal tapped holes: Minor diameter: mm Proximal oblique screws: - a-p slope: Mean of 6 towards proximal end of nail- Included angle from cephalad: 70 Herzog curvature:3 (shaft) + 7 (proximal) = 10 Connecting thread of nail: M8 Cannulation (diameter): mmImplant material:Titanium alloy Ti6AI4 VAnodized surfaceShort Nail Length: 200 mm Design: solide / canul Distal tapped M-L holes: Minor diameter: mmLong Nail Length: 240-420 mm Curvature: 2 Proximal curve: adapt e l extr mit du clou Distal tapped holes m-l and a-p: diameter: mmLong NailShort Nail70 1242 M8 8162296 9 Cap ScrewTechnical characteristics Length: 0 mm, 5 mm, 10 mm Diameter: 11.

7 5 m m Thread: M8 Compression ScrewTechnical characteristics Length: 15 mm Diameter: mm Cannulation: mm Thread: M8 Locking ScrewTechnical characteristics Thread diameter: mm Pitch: mm Length: 4 mm Hexagon key diameter: mm Self-tappingThreaded BushTechnical characteristics Length: 10 mm Thread: Major diameter 8 mm 20 - 80 material:Titanium alloy Ti6AI4 VAnodized surfaceBiomechanics10 Optimized design combines mechanical strength with functionality High strength nail despite numerous locking options and cannulation Uniform stress distribution in the critical area of tensile stress The locking options and specially designed sliding hole arrangement result in an extremely well balanced mechanical construct Zero motion effect ensures best immobilizationpossible for the fragments Figure 1 FEM analysis of the proximal Targon TX.

8 Test setup and stress distributionThe biomechanical performance of osteosynthesissystems is determined primarily by the mechanicalstrength of their components and their ability tostabilize the fracture to the Targon T, all of the most impor-tant changes in the design of the Targon TX aimto advance intramedullary nailing into the veryproximal and distal regions of the tibia while improving the fixation the design of the Targon TX the main focuswas to optimize the integration of the newly developed locking option while at the same timeimpairing the implant as little as 1 demonstrates the stress distribution atthe proximal end of the nail resulting from theFEM analysis of the locking and loading stress is seen between the holes of theproximal oblique , on the implant these holes are distributedas best as permitted by the anatomical constraints.

9 In order to offer the smoothest stress transitionsand lowest stress peaks and dimensions of the m-l holeshave been chosen such that there is a quite homogeneous stress distribution along the areasof tensile the chosen design comply with the highmechanical demands?In order to answer this question a test was set up where the nail underwent eccentric cyclic loading via the three proximal oblique allowed determination of that load which let the implant withstand one million cycles, alevel which is regarded as the fatigue strengthfor the designated meaningful reference purposes a commerciallyavailable nail from a competitor was subjected to the same test results of this comparison testing were ratherfavorable for the Targon TX.

10 The load limit of theTargon TX is 70% higher than for the other implants fail by cracking at the second proxi-mal oblique hole ( Targon TX) or the a-p hole (other nail). Figure 2 Test setup for assessing the proximal fatigue strengthOne reported common mechanism of failure inlocking tibial nailing is screw Targon TX solely relies on the proven Targon locking screws with their diameter of screws are characterized by a large minordiameter and smooth flank geometry and there-fore are perfect for steady cyclic indications for the Targon TX have been expanded significantly compared to theTargon T. Proximal metaphyseal fractures (A0 41-A2, A3) All types of shaft fractures (A0 42) Distal metaphyseal fractures (A0 43-A1, A2, A3) Combinations of these fracture types Simple proximal intraarticular fracture (41A0-C1, C2)when combined with other implants, primarily cannulated screwsThe Targon TX Short Nail is indicated whenever the conditions at the distal tibia do not permit ExampleProximal fracture ExampleDiaphyseal fracture ExampleDistal fracture14 Surgical TechniquePreoperative Planning KH483 X-ray template Targon TX (KH483200 : 375 mm-420 mmKH483201 : 315 mm-360 mmKH483202.)