TENS

TITANIUM ELASTIC NAIL

1. Dr (Major) Parthasarathy S
Pg Resident,MS Orthopaedics
Stanley Medical College,Chennai
Ref : Rockwood & Wilkin’s fractures in children 8
th
edition
The elements of fracture fixation 3
rd
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. 2/3
rd
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