Interlocking nail of tibia
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The document outlines a surgical procedure for interlocking nail fixation of a closed comminuted fracture in the midshaft of the left tibia for a 29-year-old patient. It details the approach and techniques used during surgery, including patient positioning, entry point creation, and nail insertion while emphasizing the importance of nail length and working length for successful fixation. The conclusion highlights that a shorter working length leads to stronger fixation, supported by references to relevant surgical literature.
Interlocking nail of tibia
- 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
- 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. ENTRY POINT 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
- 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: 1. Medullary reaming 2. 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