Tens

TITANIUM ELASTIC NAIL

1. TITANIUM ELASTIC NAILING SYSTEM Dr.PONNILAVAN

2. In early 1980 , flexible stable intramedullary nailing using titanium was developed in an University in Nancy, France ( hence called Nancy Nail) ( Depuy )

3. TENS is used primarily for the management of diaphyseal & metaphyseal fractures in children. - Whether the TENS is indicated or not depends upon the age of the patient & the type & site of the fracture . All three factors must be considered together.

4. Age A ge limit depends on the biological development of the child. Experience has shown that the lower limit is 3–4 years and the upper limit 13–15 years.

5. Type of fracture – Transverse fractures – Short oblique or transverse fractures with broken-off wedges – Long oblique fractures with the possibility of cortical support – Spiral fractures – Multi-fragment and bifocal fractures – Pathological fractures with juvenile bone cysts

6. Fracture site – femur: diaphyseal – distal femur: metaphyseal – femur: subtrochanteric – lower leg: diaphyseal – lower leg: distal metaphyseal – humerus : diaphyseal and subcapital – humerus : supracondylar – radius and ulna: shaft – radius: neck

7. Other possible special indications: – humerus and forearm in adults – polytrauma in combination with craniocerebral trauma, even outside the age range specified above – prophylactic stabilization with juvenile bone cysts – osteogenesis imperfecta

8. Contraindications – intraarticular fractures – complex femoral fractures, particularly in connection with overweight (50–60 kg) and/or age (15–16 years)

9. Nail size 30 to 40% of isthmus diameter Choose nails with identical diameter to avoid varus / Valgus malpositioning Each nail diameter chosen is 0.4 times the diameter of the medullary canal.

10. FART stability

11. Pre-bend nails

12. Vertex of arch should be located at the level of # zone . Pre-bend both nails in exactly the same way. Pressure applied internally can be increased by prebending the nails to a smaller diameter, thus shifting the nail crossover points more towards the metaphyses . This can increase the stability in complex fractures.

13. TENS serve as load sharing devices Flexible enough to allow bending and avoid the need to cross the physis during their insertion. Relatively small incisions confer a cosmetic advantage to the traditional plating techniques. These nails are easy to remove, and allow for early ambulation (48–72 hours).

14. Ascending technique FEMUR - standard Radius Proximal humerus # Do not prebend for radial head/neck #

15. Descending technique Tibia Ulna Femur Distal humerus # ( TUFdh )

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