Featured products within the trigen family include. Nailing in extension for trigen meta nail tibial nails. For implantation using the suprapatellar approach, instrumentation systems trigen meta tibia nail. Intramedullary nail fixation remains the treatment of choice for unstable and displaced tibial shaft fractures in the adult. We report a case of inadvertent penetration of the tibiotalar joint by the smooth guide wire caused by incarceration of a fracture fragment between the nail and. Rehabilitation following bilateral tibial intramedullary. Deborah michael wendland, pt, dpt, phd, cped mercer university atlanta, ga abstract background. Efficacy study of surgical technique in intramedullary. The compliance of the nail construct was adjusted by overdrilling the near cortex reliable fracture union since the surgeon can. Expert nailing system titanium cannulated tibial nail. 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. The tibia is the most commonly fractured long bone, with tibial diaphyseal fractures accounting for 6. Utilizing the same trigen instruments, the tan was developed to simplify the surgical approach by allowing placement of the nail through the greater trochanter instead of the piriformis fossa.
We experienced three cases of refracture and two cases of failure to remove the nail while trying to take out ace tibial nails from healed tibial fractures. When treating distal tibia fractures with a tibial nail, stresses are increased on the nails distal portion. Suprapatellar nailing of tibial fractures is a simple method with many advantages over traditional tibial nailing. In 20042005 our hospital took part in the multicenter clinical trial. Nonunion of long bones fixed with nails may result in implant failure. Intramedullary nailing seminar by dr ashwani panchal. Current biomechanical improvement efforts aim to enhance the boneintramedullary nail system stability.
Intramedullary im nailing is the preferred method of treatment for tibial stress fractures because of. Trigen knee nail and distal tibial nail specifications driving end of nail all knee nails and distal tibia nondriving end of nail ml view the distal tibial nail is on limited release, in the us market. Pdf fatigue strength of common tibial intramedullary. Tibial fracture repair with titanium intramedullary rod duration. The objective of this study is to analyze the proximal tibiofibular joint in patients with knee pain after treatment of tibial shaft fractures with locked intramedullary nail. The intramedullary nail is commonly used for longbone fracture fixation and has become the standard treatment of most longbone diaphyseal and selected metaphyseal fractures1 to understand the intramedullary nail, knowledge of evolution and biomechanics are helpful 2. The device is indicated for degeneration, deformity, or trauma of both the tibiotalar and talocalcaneal articulations in the hindfoot.
Complications associated with the metanail tibial nail end. Tibial nail with locking screws in place, making the entry portal ce. Apr 20, 2017 dental assisting training video for dental office staff. Trigen metanail tibial nail system surgical technique. Ten screws of each type listed in table 1 were tested in single screw configuration. Unusual complication following intramedullary nailing of. The risk of iatrogenic injury to anterior tibial artery. Both antegrade femoral nails are designed to accommodate a standard femoral locking mode or the recon locking mode in the same leg. Trigen metanail tibial nail specifications driving end of nail all knee and distal tibial top view of nail ml view nondriving end of nail ap view does not include all sizes.
Mar 31, 2016 this bone model has been previously used for several biomechanical studies. Tibial intramedullary nail 3d cad model library grabcad. Removal of a broken cannulated intramedullary nail. Rehabilitation following bilateral tibial intramedullary nail placement in an elite athlete sharon young abney, spt. Ap f and lateral g views of medullary reamers over the guide pin. For nail sizes 12 and mm, the proximal nail diameter matches the shaft diameter. Inadvertent complications during this stage have been reported. The trigen sureshot distal targeting system utilizes an electromagnetic field generator, a probe inserted into the nail, and virtual imaging to facilitate distal locking without fluoroscopy. The new trigen semiextended instrumentation facilitates intramedullary nailing procedures of the tibia with less flexion of the knee joint. Intramedullary nailing seminar by dr ashwani panchal 1.
This in vitro study showed that, when using the expert tibial nail for unstable distal tibial fractures, the classic configuration of 2 parallel distal screws. Russell, md, mba university of mississippi medical center treatment goals shaft fracture. Trigen intramedullary nails are designed to reduce radiation, increasing efficiency and simplify techniques. Fatigue strength of common tibial intramedullary nail distal locking screws article pdf available in journal of orthopaedic surgery and research 41. For more information on the trigen metanail tibial nail system, including its indications for use, contraindications, and product safety information, please refer to the products label, the instructions for use ref 81068703 packaged with the product, and, if using the trigen sureshot distal targeting system, the trigen sureshot. Wchcoated fixation kwires designed for secure fixation in tibial plateau to prevent anteriorization and back out of sleeves during reaming. T2 tibia spi offers two size options of drill sleeve available to accommodate nail diameters 8mm. In order to determine the risk factors associated with difficulties in nail removal, these five patients were compared in the parameters of age, gender, duration of nail in situ, nail diameter, nail length, and level of fracture with 30. Enhanced fixation via threaded screw holes and polyethylene bushings offer better solutions for the fixation of complex fractures. Trigen humeral nail surgical technique pdf writer telegraph. Fatigue strength of common tibial intramedullary nail. The standard surgical technique in intramedullary tibia nailing is with the knee in almost 90 degrees of flexion. In 1958, the ao formulated four basic principles, which have become the guidelines for internal fixation in general,1. The nails may be either solid or cannulated hollow.
Trigen intertan intramedullary nail versus sliding hip screw a prospective, randomized multicenter study on pain, function, and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year of followup kjell matre, md, tarjei vinje, md, leif ivar havelin, md, phd, janerik gjertsen, md, phd, ove furnes, md, phd. The proximal section of the implant is mm and is angled at 5 to accommodate the more lateral entry site. Preoperative evaluation of intramedullary tibial nail. Twentynine patients were included from our hospital. Download download trigen humeral nail surgical technique pdf writer read online read online trigen humeral nail surgical technique pdf writer official fulltext paper pdf. Many methods have been described to allow for removal of the broken piece of the nail. Length alignment rotation mobile joint mobile joint wb extremity when to nail gold standard for tibial shaft fractures possible in proximal and distal tibial fractures with appropriate technique. This system is ionizing radiation free, position independent, and provides 3d real time feedback of location and orientation of the drill relative to the. Elastic nail insertion sleeves designed to serve as working channel to protect joint space.
Dec 30, 2015 suprapatellar nailing of tibial fractures is a simple method with many advantages over traditional tibial nailing. The trigen meta nail tibial nail system is designed specifically to repair fractures of the proximal and distal thirds of the tibia, including the shaft, stable and unstable fractures, nonunions, malunions, and for the prophylactic nailing of impending pathological fractures. Intramedullary nailing is a standard form of treatment for diaphyseal tibial fractures. Phoenix tibial nail system featuring corelocktm technology. The titanium tibial nail system royal childrens hospital. Intramedullary nails used in trauma surgeries as internal fixation for different indications intertrochanteric fractures, retrograde femoral fracture, hindfoot fractures, tibial fractures. Trigen intramedullary nailing system trigen sureshot distal targeting system trigen meta nail retrograde femoral nail trigen meta nail tibial nail trigen meta nail nailing in extension instrumentation trigen fan femoral antegrade nails trigen tan trochanteric nails trigen intertan intertrochanteric antegrade nail trigen hindfoot fusion nail trigen humeral nail with sureshot. Numerous reduction techiques are available to achieve an anatomic. Recently, suprapatellar nailing in the semiextended position has been suggested as a safe and effective surgical technique. Efficacy study of surgical technique in intramedullary tibia nailing, using trigen meta tibia nails trigenmeta. The trigen metanail tibial nail system is designed specifically to repair fractures of the proximal and distal thirds of the tibia, including the shaft, stable and unstable fractures, nonunions, malunions, and for the prophylactic nailing of impending pathological fractures. It is composed of a titanium alloy and is available in 4 diameters 8. With a full range of sizes, the tibial nail is a comprehensive approach to the treatment of tibial fractures.
Extending the indications of intramedullary nailing with. Figure 5 preoperative view demonstrating fragment at frac. The titanium tibial nail system the royal childrens. The trigen meta nail tibial nail is the latest addition to the trigen family of intramedullary nails. For distal tibia fractures, it is recommended that the surgeon use the largest nail diameter that will fit in the medullary canal, without excessive thinning of. Depending on the anatomical situation, nail lengths between. There is room for development of the method and improvement of instruments, thus increasing safety and indications. Figure 3 preoperative view, no fragment visible in the ankle joint.
Generally, a nail diameter 1 mm less than the final reamer diameter is chosen. It is a computerassisted orthopaedic surgery tool to aid the surgeon with drill positioning for screws during intramedullary nail implantation. Insertion of the nail requires threading of the nail over a smooth guidewire. Enhanced fixation via threaded screw holes and polyethylene bushings offer excellent solutions for the fixation of complex fractures.
For nail sizes 811 mm, the proximal diameter is 11. Efficacy study of surgical technique in intramedullary tibia. Tests were conducted at twenty hz using a custom fixture that simulated the distal end of a 11. Distal locking screws for intramedullary nailing of tibial. Extending the indications of intramedullary nailing with the. Nailing in extension for trigen metanail tibial nails. The use of a cannulated expert tibial nail with a large diameter offering more stability associated with. Tibial nails have locking screw holes close to both ends, in multiple orientations, for better fixation of proximal and distal fractures. Specifications trigen fan nail material ti6al4v diameter 10, 11.
Intramedullary tibial nail insertion was performed following reaming for all patients. The t2 tibial nailing system is the realization of superior biomechanical intramedullary stabilization using small caliber, strong cannulated. Figure4 postoperativeview,fragmentclearlyvisibleinankle joint. In the international markets, the distal tibial nail is sold in select countries. Tibial bone transport over an intramedullary nail using cable and pulleys duration. Tibial intramedullary nailing suprapatella approach. Trigen meta nail tibial nail specifications driving end of nail all knee and distal tibial top view of nail ml view nondriving end of nail ap view does not include all sizes.
Establishing an appropriate starting point is a crucial part of the surgical procedure. Rehabilitation following bilateral tibial intramedullary nail. Complications associated with the metanail tibial nail. Jan 04, 2015 intramedullary nailing seminar by dr ashwani panchal 1. Trigen metanail tibial nail specifications driving end of nail all knee and distal tibial top view of nail nondriving end of nail ml view ap view set does not include all sizes. The proximal tibiofibular joint was analyzed in 30 patients, who reported knee pain after tibial nailing, and standard radiograph and computed tomography were performed to examine the proximal third of the tibia. Reduced flexion leads to less pull from the quadriceps mechanism, helping to avoid fracture malreductions and misalignment the semiextended technique offers reductions, imaging and less angulation of the proximal segment while offering the enhanced.
The titanium tibial nail system surgical technique 16 inserting the nail for the solid utn, place the nail into the tibial opening with the insertion handle oriented anteriorly. Difficulties in removing ace tibial intramedullary nail. Intraarticular fragment extrusion during tibial intramedullary nailing 5 figure 1 cortical surface of fragment. The phoenix tibial nail system is composed of titanium alloy and features corelock technology that offers a preassembled, embedded locking mechanism for locking all proximal oblique screws, which can also be used to internally mechanically compress up. The trigen semiextended instrumentation facilitates intramedullary nailing procedures of the tibia with less flexion of the knee joint. For the cannulated ctn, place the nail over the guide rod and into the tibial opening with the insertion handle oriented anteriorly. Trigen intertan intramedullary nail versus sliding hip screw.
Mar 02, 2017 tibial bone transport over an intramedullary nail using cable and pulleys duration. Removal of a broken intramedullary nail may be a real challenge. During postoperative followups in our institutes outpatient clinic, we have collected 27 cases of intramedullary nail fixation of unilateral tibial diaphysial fracture in patients aged 18 to 80 years. The goals of surgical treatment are to achieve osseous union and to restore length, alignment, and rotation of the fractured tibia. Pdf fatigue strength of common tibial intramedullary nail. The trigen metanail tibial nail is indicated for fractures of the proximal and distal third of the tibia, including the shaft, stable and unstable fractures, nonunions, malunions, and for the prophylactic nailing of impending pathological fractures. We used two fixtures, which produce a simply supported bending condition with a span of 15. Semiextended approach for intramedullary nailing via a. The t2 tibial nailing system represents strykers latest and most comprehensive development of the original intramedullary principles presented by prof. The trigen metanail tibial nail is indicated for fractures of the proximal and distal third of the tibia, including the shaft, stable and unstable metaphyseal fractures, nonunions, malunions, and for the prophylactic nailing of impending pathological fractures.
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