Interlocking nail of tibia

regarding managemant of tibia fracture using interlocking nail...

this is not my note, i share it for reading purpose only.

1. INTERLOCKING NAIL OF TIBIA PREPARED BY: DR. TAN YONG JIA

2. OUTLINE Patient brief history Approach to interlocking nail of tibia Length and working length Patient’s outcome References

3. Brief history 29 years old malay gentleman No known comorbids Alleged MVA, sustained closed comminuted fracture midshaft of left tibia Planned surgery: Interlocking nail

4. Pre-op x-rays

5. Approach to interlocking nail of tibia Patient is placed on supine position Left lower limb is clean and drapped Figure of 4 position is used Skin incision is extended about 3cm proximal to the tibial plateau at the anterior aspect of the left knee Patella tendon is incised longitudinally in line with the medullary cavity

6. In the frontal plane: in line with the medullary canal (3 mm medial of the tibial crest) In the sagittal plane: just distal to the angle between tibial plateau and anterior tibial metaphysis ENTRY POINT

7. Solid curved awl is used to create an entry point for nail Fracture is reduced and ball-tipped guide wire is inserted Medullary cavity is reamed starting from smaller size reamer. Medullary cavity should be reamed 1 size larger than the intended nail Tissue protector is used during reaming procedure Daflon is inserted and straight guide wire is inserted to replaced the ball-tipped guide wire Length of the nail is measured using radiographic ruler Nail of appropriate length and diameter is inserted Guide wire is removed and proximal and distal locking screws are inserted Patella tendon is repaired , paratenon is sutured. Subcutanous tissue and skin is closed

8. CHECK X-RAYS

9. Length and working length Total nail length Length of nail-bone contact Larger the contact area, the higher the resistance to motion Working length

10. Total nail length Too long a nail protruding at the insertion site causes pain and limitation on motion Too short a nail compromises fixation

11. Length of nail bone contact Total surface area of contact between the nail and bone Larger the contact, higher the resistance to motion

12. Working length

13. Reflects the nail carrying the major load of stress across the fracture site Bending stiffness of a nail is inversely proportional to square of its working length Torsional stiffness is inversely proportional to its working length Conclusion: shorter working length means stronger fixation 2 ways of modifying the working length: Medullary reaming Interlocking

14. NAILS AVAILABLE IN OT 4.5CM 5CM 7.5CM 4CM 4CM 5CM

15. XOA ON TCA 6 WEEKS

16. REFERENCES AO Trauma surgery reference The elements of fracture fixation, Anand J. Thakur

17. THANK YOU