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UTN/CTN Solid/Cannulated Tibial Mobile/Synthes International... · PDF file 2 DePuy Synthes UTN/CTN – Solid/Cannulated Tibial Nail Surgical Technique AO Principles Stable fixation

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  • 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

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