TIBIAL NAILING SYSTEM OPTIONS MADE EASY

1 SURGICAL TECHNIQUETIBIAL NAILING SYSTEMOPTIONS MADE EASYTABLE OF CONTENTS1236/771213141516 DESIGN SUMMARYINSTRUMENT OVERVIEW AND JIG OPTIONSENTRY AND CANAL PREPNAIL INSERTIONLOCKINGNAIL REMOVALBLOCKING SCREW TECHNIQUEESSENTIAL PRODUCT INFORMATIONIMPLANTSINSTRUMENT CATALOG NUMBERS AND DESCRIPTIONSNote:This brochure presents a surgical technique available for use with the DePuyOrthopaedics, Inc. VersaNail Platform instruments and implants. Surgeons may need to makemodifications as appropriate in their own surgical technique with these devices depending onindividual patient EASYOPTIONS The DePuy VersaNail TIBIAL Nail SYSTEM is part of a long bonenailing SYSTEM that offers a complete portfolio of implants andinstruments based on a standardized technology platform.

2 DESIGN SUMMARYThe TIBIAL Nail SYSTEM from the VersaNail Platform offers an optimalimplant design to treat a range of tibia fractures from simple tocomplex, with versatile locking OPTIONS . The VersaNail Platforminstrumentation is designed to provide OPTIONS and flexibility for manyintraoperative approaches (including percutaneous methods) whilemaintaining ease of use and commonality. IMPLANT MATERIALAll implants are manufactured from 6Al-4V ELI grade, type II anodized titaniumalloy (TiMAX ) due to this material s superior properties. TiMAX offers a lowermodulus of elasticity and increased fatigue strength over stainless SUMMARYINSTRUMENT OVERVIEW AND JIG OPTIONS2 InstrumentsThe VersaNail Platform instrumentation SYSTEM is designed to be intuitive, enabling asimpler and more efficient procedure.

3 The VersaNail Platform s modular naturefacilitates the use of common instruments across all VersaNail NAILING systems,reducing confusion among the OR staff. For example, VersaNail Platform jigs lookand function the same way, and common instruments (such as awls, entry portals,guide wires, nail length gauge, locking instrumentation and screw caddies) can beused across all VersaNail Platform NAILING OptionsTwo jig OPTIONS are available for the VersaNail TIBIAL Nail and are designed toaccommodate varying approaches to incision low-profile jig allows radiolucent targeting and isdesigned with a very low-profile jig nose ( ).

4 This makes it useful for a standard approach, such as a split-patellatendon technique, which requires instrumentation that will notimpinge on the patella during nail insertion and allows greaterlimb extension during extended tibia jig features an extended nose, toaccommodate a higher incision point, for a more percutaneousapproach if desired (Fig. 2). This jig is designed with the jigmechanics up and out of the way so that the entry site canbe targeted from a distance. The targeting arm rotates withthe push of a button to target the proximal locking rotating design also allows the jig to be repositioned forconvenience during the NAILING procedure without disassemblyto improve visualization of the nail seating and screw 1 Fig.

5 2 Locking instrumentation is color-coded by screw size for simplicity: Color GuideScrew SizeDrill Bit SizeInstrumentsProximal Locking mm Sheath, Trocar, Drill GuideDistal Locking mm mmCalibrated Drill SleeveENTRY AND CANAL PREP3 Fig. 3 Entry Site and Surgical ApproachMake a proximal incision along the medial aspect of thepatellar tendon (Fig. 4). For more proximal fractures, a lateralperi-tendinous approach may be beneficial based on surgeonpreference. Continue deep dissection until the proximalaspect of the tibia is starting point is made either with a mm x 14 pin (Cat.)

6 No. 2810-01-036) or an awl, based onsurgeon preference (Fig. 5). Use A/P and lateral fluoroscopicviews to confirm accurate placement. For midshaft and distaltibia fractures, a central starting point in the A/P view isadequate. For more proximal fractures, however, a slightlylateral starting point is recommended to avoid proximalfragment 6 Use the awl (Cat. No. 2810-01-005) or mmcannulated entry reamer (Cat. No. 2810-12-002) to open theproximal tibia. If required, an entry portal sleeve (Cat. ) is available for soft tissue protection (Fig. 6).Fig. 5 Fig.

7 4 Patient PositioningPosition the patient supine on a radiolucent table (Fig. 3).Knee flexion will assist with identification of the anatomiclandmarks to allow accurate incision placement. For ease ofdistal locking from the medial direction, it is helpful to placethe C-arm on the opposite side of the injured verify the entry point and advance theawl or mm entry reamer in line with the TIBIAL canal (Fig. 7). The entry reamer is marked to identify the correctreaming depth depending on whether dynamization will beused. The TIBIAL nail dynamization range is 7 7 Once access to the TIBIAL canal has been gained, place theball nose guide wire into the entry site utilizing the guide wiregripper.

8 Two guide wire gripper styles are available dependingon surgeon preference: the pistol grip (Cat. No. 2810-01-001)or the T-handle grip (Cat. No. 2810-01-002) (Fig. 8).Fracture ReductionObtain appropriate anatomic reduction in order to restorelength, alignment and rotation of the injured limb. Reductioncan be achieved through the surgeon s preferred methodsuch as traction and/or an external fixator. To aid inmanipulating the fracture fragments and passing the ball noseguide wire, large ( mm diameter, Cat. No. 2810-01-007)and small ( mm diameter, Cat. No. 2810-01-008)reduction tools are the reduction tool into the medullary canal, pastthe fracture site (Fig.)

9 9). Once the fracture is in alignment,place the ball nose guide wire, available in both 80 cm (Cat. No. 2810-01-080) and 100 cm (Cat. No. 2810-01-100)lengths. Remove the reduction PreparationAchieve excellent alignment of the injured limb prior to reaming and maintain itthroughout the reaming process to avoid eccentric reaming. Commence reaming by placing an intramedullary flexible reamer over the DePuy ball nose guide the medullary canal in half-millimeter increments until cortical bone is the reaming procedure using image intensification to avoid eccentric orexcessive cortex 9 Fig.

10 8If dynamic locking isplanned, ream to the mostproximal groove on theshaft of the entry Size Selection An X-ray template is availableto determine nail sizepreoperatively (Cat. No. 2810-12-020) (Fig. 10).Fig. 10 Nail Diameter SelectionGenerally, a nail diameter 1 mm less than the final reamer diameter is chosen. Fornail sizes 8-11 mm, the proximal diameter is mm. For nail sizes 12 and 13 mm,the proximal nail diameter matches the shaft treating distal tibia fractures with a TIBIAL nail, stresses are increased on the nail s distal portion. For distal tibia fractures, it is recommended that the surgeon use the largest nail diameter that will fit in the medullary canal, without excessivethinning of the cortex.