Titelblatt UTN/CTN
UTN/CTN
Solid/Cannulated
Tibial Nail
Surgical Technique
356.590 Radiographic Ruler for UTN/CTN, length 430 mm
351.060 Centering Pin B 4.0 mm, length 400 mm, for No. 351.240
393.100 Universal Chuck with T-Handle
351.240 Cutter for UTN/CTN and Universal Medullary Nail
351.260 Protecting Sleeve, for No. 351.240
356.490 Inserter/Extractor for UTN/CTN and UHN
332.200 Slotted Hammer
321.160 Combination Wrench B 11.0 mm
356.542 Connecting Screw for UTN, for No. 356.511
356.544 Connecting Screw for CTN, for No. 356.511
356.543 Extraction Screw for UTN/CTN
356.511 Insertion Handle for UTN/CTN
356.521 Aiming Arm for UTN/CTN
458.XXX Locking Bolt B 3.9 mm, self-tapping, TAN
459.XXX Locking Bolt B 4.9 mm, self-tapping, TAN
258.XXX Locking Bolt B 3.9 mm, self-tapping, Stainless Steel
458.110* End Cap for UTN, extension 15 mm, TAN
258.110 End Cap for UTN, extension 15 mm, Stainless Steel
458.100 End Cap for UTN B 8.0, 9.0 and 10.0 mm, TAN
258.100 End Cap for UTN B 8.0, 9.0 and 10.0 mm, Stainless Steel
458.120 End Cap for CTN, Titanium Alloy (TAN), green
47X.XXX UTN-Solid Tibial Nail, complete, with End Cap, TAN
27X.XXX UTN-Solid Tibial Nail, complete, with End Cap,
Stainless Steel
485.XXX CTN-Cannulated Tibial Nail, TAN
355.700 Protection Sleeve 11.0/8.0
355.750 Trocar B 8.0 mm
355.722 Drill Sleeve 8.0/3.2, dark blue
357.711 Drill Sleeve 8.0/4.0, green
355.720 Drill Sleeve 8.0/3.2
315.330 Drill Bit B 3.2 mm, calibrated
356.982 Drill Bit B 4.0 mm, calibrated
355.790 Depth Gauge for Locking Bolts,
measuring range up to 90 mm
314.240 Screwdriver, hexagonal, small, B 2.5 mm, with Groove,
length 250 mm
314.750 Screwdriver, hexagonal, large, B 3.5 mm, with Groove
314.280 Holding Sleeve, large
Available non-sterile or sterile packed. Add "S" to the article number to order sterile products.
*Also available in TAV.
Only for UTN
511.750 AO/ASIF Quick Coupling, for Compact Air
Drive and Power Drive
511.701 COMPACT AIR DRIVE II
355.041 Guide Rod B 3.0 mm, with flat tip,
length 950 mm
356.530 Nut, knurled, for UTN
356.540 Connecting Screw for UTN
356.520 Insertion Handle 45° for UTN
356.510 Insertion Handle for UTN
356.570 Coupling Block for UTN
356.580 Coupling Block with Square Sleeve for UTN
356.560 Coupling Block for Extraction of UTN
Image intensifier control
This description alone does not provide sufficient background for direct use
of DePuy Synthes products. Instruction by a surgeon experienced in handling
these products is highly recommended.
Processing, Reprocessing, Care and Maintenance
For general guidelines, function control and dismantling of multi-part
instruments, as well as processing guidelines for implants, please contact your
local sales representative or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
For general information about reprocessing, care and maintenance of Synthes
reusable devices, instrument trays and cases, as well as processing of Synthes
non-sterile implants, please consult the Important Information leaflet
(SE_023827) or refer to:
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
UTN/CTN – Solid/Cannulated Tibial Nail Surgical Technique DePuy Synthes 1
Table of Contents
AO Principles 2
Indications/Contraindications 3
Indications for Tibial Nailing 4
Implants 10
Surgical Technique 12
Implant Removal 29
Option for UTN 30
Dimensions of Implants and Instruments
for Proximal and Distal Locking 31
MRI Information 33
References 34
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4_Priciples_03.pdf 1 05.07.12 12:08
4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique
AO PRINCIPLES
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal fixation1, 2.
1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal
Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.
2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management.
2nd ed. Stuttgart, New York: Thieme. 2007.
Anatomic reduction
Fracture reduction and fixation to
restore anatomical relationships.
Early, active mobilization
Early and safe mobilization and
rehabilitation of the injured part
and the patient as a whole.
Stable fixation
Fracture fixation providing abso-
lute or relative stability, as
required by the patient, the injury,
and the personality of the
fracture.
Preservation of blood supply
Preservation of the blood supply
to soft tissues and bone by
gentle reduction techniques and
careful handling.
2 DePuy Synthes UTN/CTN – Solid/Cannulated Tibial Nail Surgical Technique
AO Principles
Stable fixation
Fracture fixation providing absolute
or relative stability, as required by
the patient, the injury, and the per-
sonality of the fracture.
Anatomic reduction
Fracture reduction and fixation
to restore anatomical relationships.
Early, active mobilization
Early and safe mobilization and
rehabilitation of the injured part
and the patient as a whole.
Preservation of blood supply
Preservation of the blood supply
to soft tissues and bone by gentle
reduction techniques and careful
handling.
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal fixation1,2.
1 Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation.
3rd ed. Berlin, Heidelberg, New York: Springer. 1991.
2 Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed.
Stuttgart, New York: Thieme. 2007.
00-Indikation
UTN/CTN – Solid/Cannulated Tibial Nail Surgical Technique DePuy Synthes 1
Indications/Contraindications
The Solid Tibial Nail (UTN) and Cannulated Tibial Nail
(CTN) are used for the fi xation of tibial shaft fractures.
Because of its anatomical cross-section, the UTN is more
suited to the unreamed technique, while the CTN, with
its round cross- section, is more suited to the reamed
technique.
Indications for UTN
• Fractures, types 42-A to 42-C
• Closed fractures, types 0 to 3 (Tscherne classifi cation)
• Open fractures, types I to IIIA, IIIB and IIIC
(Gustilo classifi cation)
Contraindications for UTN
• Infections
• Pseudoarthroses
• Nonunions
Indications for CTN
• Fractures, types 42-A to 42-C
• Closed fractures, types 0 to 2 (Tscherne classifi cation)
• Open fractures, types I to IIIA (Gustilo classifi cation)
• Pseudoarthroses
• Nonunions
Contraindications for CTN
• Infections
• Closed fractures, type 3 (Tscherne classifi cation)
• Open fractures, types IIIB and IIIC (Gustilo classifi ca-
tion)
4 DePuy Synthes UTN/CTN – Solid/Cannulated Tibial Nail Surgical Technique
The number of different implants available for intramed-
ullary fixation of the tibia has grown over the years. The
implants differ in their design (slotted/unslotted, solid/
cannulated, small diameter/large diameter, static locking/
dynamic locking), materials (steel/titanium), technical
application (with/without/single reaming) and price.
Considerable overlap exists for the indications.
The following table prepared by the Long Bone Expert
Group (LBEG) of the Technical Committee of the
AO/ASIF provides an overview of the indications for
Synthes tibial nails.
Implants Indications Limitations
All intramedullary implants for the tibia • Diaphyseal fractures
• Metaphyseal fractures where locking bolts can
still be placed and will result in stable aligned
fracture fixation
• Severe contamination
• Presence of acute infection
• Metaphyseal fractures where locking bolts cannot be
placed adequately (poor bone stock) or when fixation
is expected to be unstable
AO Universal Tibial Nail
unlocked, reamed application
• Axially and rotationally stable fracture patterns
(AO classification 42-A1 to 42-A2) in the middle
third of the tibia
• Pseudoarthroses/nonunions if axially and
rotationally stable
• Axially and rotationally unstable fractures
(42-A3 to 42-C)
• Fractures in the proximal and distal third of the tibia
• Closed fractures grade 3 (Tscherne)
• Open fractures grade IIIB and IIIC (Gustilo)
• Cases with increased risk of septic complications
AO Universal Tibial Nail
locked, reamed application
• All 42-A to 42-C fractures (AO classification)
in the middle three fifth of the tibia
• Closed fractures grade 0 to 2 (Tscherne)
• Open fractures grade I to IIIA (Gustilo)
• Pseudoarthroses / nonunions
• Closed fractures grade 3 (Tscherne)
• Open fractures grade IIIB and IIIC (Gustilo)
• Cases with increased risk of septic complications
UTN S
