TITANIUM ELASTIC NAIL

1. Dr (Major) Parthasarathy S
Pg Resident,MS Orthopaedics
Stanley Medical College,Chennai
Ref : Rockwood & Wilkin’s fractures in children 8th
edition
The elements of fracture fixation 3rd
edition

2.  Primary definitive fracture care
 Thick periosteum
 Biological healing
 Minimal soft tissue insult
 Callus promoting micro movements
 Maintains length,rotation,alignment

3.  In the mid-19th century,rigid ivory pins were
used
 Intramedullary fixation was typified by the
Küntscher nail
 difficulties encountered in trying to avoid the physes.

4.  The Rush nail
 forerunner of modern elastic intramedullary fixation
 three-point fixation
 slightly flexible
 pre-bent
 rotational stability was poor
 flexibility was insufficient

5.  Hackethal Marchetti
 bundles of thinner wires which filled the medullary cavity
 Stabilisation achieved by splaying the ends of the wires
 Ender
 safely inserted into the metaphysis

6.  In the early 1980s, surgeons in Nancy,France
 Developed an elastic stable intramedullary nail based
on a theoretical concept by Firica.
 elasticity and stability combined in one construct
 two pre-tensioned nails inserted from opposite sides
of the bone
 Metazieau, Ligier et al were able to show that
titanium nails which were accurately contoured and
properly inserted could impart excellent axial and
lateral stability to diaphyseal fractures in long bones.
 Rotational stability weakest point of the technique

7.  Young’s/elastic/tensile modulus-object’s
resistance to being deformed elastically
 Young’s modulus=stress/strain
 Stress-forcing causing deformation/area
 Strain-change in length

11.  Precurved-3 times the narrowest diameter of
bone
 Maximum curvature in fracture zone
 2 nails inserted often
 Opposite to each other
 4 properties
 Flexural,axial,rotational,transitional stability

13.  3 point fixation
 Entry point
 Fracture zone
 Far end in dense metaphyseal area

16.  Intraarticular fracture
 Complex fracture particularly in connection
with overweight & age >15

17.  1.5mm -300mm long
 2-4mm – 440mm long
 End caps

18.  Position –supine
 Reduce fracture – F tool

19.  Nail size
 30-40% of isthmus diameter
 Identical nail chosen to avoid valgus/varus
deformity

20.  Insertion point
 2.5-3 cm proximal to distal epiphyeal plate
 One finger breadth above upper pole of patella
 Avoid joint capsule & epiphysis

21.  Skin incision
 Open medullary cavity
 Bone awl/drill bit

22.  Prebend nail

23.  Insert nail and advanse

25.  The tip should reach metaphysis
 The nail’s second crossover should
be after crossing # site

26.  Trim nails

27.  Final positioning

29.  Monolateral insertion
 Anterolateral in subtrochanteric area
 Prebend nail ‘S’ shape

32.  Closed unstable #
 Irreducible #
 Polytrauma
 Always descending technique
 Medial & lateral of tibial tuberosity
 Nail tip curved posteriorely-antecurvation

36.  2/3rd
of medullary isthmus nail size
 Radius
 Ascending technique
 2cm proximal to distal epiphyseal plate
 Superficial radial nerve

37.  Ulna
 Descending technique
 2cm distal to apophyseal
plate
 Olecranon apophysis

38.  Tips point towards each other
 Oval bracing of interosseous membrane

40.  Do not prebend

42.  Monolateral
 Prox humerus/shaft

44.  Monolateral
 Distal #
 Attachment point of deltoid

46.  Pain at insertion site(most common)
 Nail tip irritation
 Skin infection
 Implant failure
 Unacceptable angulation
 Malrotation