Interlocking Nails For Femur Tibia And Supra Condylar

Interlocking Nails Femur, Tibia and Supracondylar

IMN

Introduction

The femoral, tibial and supracondylar nails in the JMF Nailing system are manufactured from unslotted, cylindrical closed-section high tensile strength stainless steel. Superior torsional resistance of this design is an important advantage in comparison with conventional slotted designs. A gentle taper at the tip allows easy insertion. The JMF femur nails feature upward, transverse, downward and miss-the-nail locking options for ipsilateral fracture configurations. The same nails are used for left and right femora reducing inventory and simplifying handling which are key benefits to operating surgeons and operating room staff. The JMF tibia nails have proximal locking screws which are oriented at 45° to the long axis of the tibia. These screws are safer to introduce than conventional A-P screws and allow excellent purchase in the posterior cortices. All nails are constructed with a reinforced distal locking hole which is located at the distal tip of the nail. This locking hole allows these nails to be used with more distal fractures when compared with most systems. Small Diameter Nails Smaller diameter nails (Dia 9 & 10mm) are available for patients with small medullary canals. Modular design instrumentation enables the insertion and locking of small diameter nails with the same instruments used for standard diameter nails. New Generation Instrumentation the JMF system features specially designed insertion instrumentation with polymer shock-absorbing washers which absorb impaction loads. The instrumentation is extensively tested for reliability in preventing thread loosening during nail impaction. Indications the JMF femoral locking nail system can be used for a wide range of stable and unstable fracture configurations including • Proximal and distal fractures • Two part fractures • Segmental fractures • Comminuted fractures with or without bone loss • Ipsilateral fractures • Proximal or distal non unions and malunions • Corrective osteotomies • Prophylaxis of pathological fractures

Femoral Nail Length of proximally enlarged section of nail (all diameters)

85 mm

Diameter of proximally enlarged section of nail (9 and 10mm nails)

12 mm

Diameter of proximally enlarged section of nail (10 and 12mm nails)

14 mm

Distance of transverse locking proximal screw hole from proximal tip of nail

40 mm

Distance of distal tip screw hole from distal tip of nail

5 mm

Radius of curvature

3000 mm

Tibia Nail Length of proximally enlarged section of nail (all diameters)

55 mm

Diameter of proximally enlarged section of nail (9 and 10mm nails)

12 mm

Diameter of proximally enlarged section of nail (10 and 12mm nails)

14 mm

Distance of first proximal screw hole from proximal tip of nail

30 mm

Distance between first two proximal screw holes

10.5 mm

Distance of distal tip screw hole from distal tip of nail

5.0 mm

Location of nail bend with reference to proximal nail tip

60mm

Bend angle (degrees) Dia 9 and 10mm

13°

Bend angle (degrees) Dia 11 and 12mm

6°

Supra-Condylar Nail Length of proximally enlarged section of nail (all diameters)

39 mm

Diameter of proximally enlarged section of nail (9 and 10mm nails)

14 mm

Diameter of proximally enlarged section of nail (10 and 12mm nails)

14 mm

Distance of first distal locking hole from distal nail tip

20 mm

Distance of second distal locking hole from first distal locking hole

10 mm

Distance of most proximal locking hole from proximal nail tip

15 mm

Distance of second proximal locking hole from first

20mm

Location of nail bend (distance from distal tip)

45mm

Nail bend angle

2

8°

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

IM Implants

IMN

Antegrade Femoral Nail For reamed and un-reamed insertion

12-1100

FEMORAL NAIL, L.30CM, DIAM. 9MM

12-1101

FEMORAL NAIL, L.32CM, DIAM. 9MM

12-1102

FEMORAL NAIL, L.34CM, DIAM. 9MM

12-1103

FEMORAL NAIL, L.36CM, DIAM. 9MM

12-1104

FEMORAL NAIL, L.38CM, DIAM. 9MM

12-1105

FEMORAL NAIL, L.40CM, DIAM. 9MM

12-1106

FEMORAL NAIL, L.42CM, DIAM. 9MM

12-1107

FEMORAL NAIL, L.44CM, DIAM. 9MM

12-1108

FEMORAL NAIL, L.46CM, DIAM. 9MM

12-1109

FEMORAL NAIL, L.30CM, DIAM. 10MM

12-1110

FEMORAL NAIL, L.32CM, DIAM. 10MM

12-1111

FEMORAL NAIL, L.34CM, DIAM. 10MM

12-1112

FEMORAL NAIL, L.36CM, DIAM. 10MM

12-1113

FEMORAL NAIL, L.38CM, DIAM. 10MM

12-1114

FEMORAL NAIL, L.40CM, DIAM. 10MM

12-1115

FEMORAL NAIL, L.42CM, DIAM. 10MM

12-1116

FEMORAL NAIL, L.44CM, DIAM. 10MM

12-1117

FEMORAL NAIL, L.46CM, DIAM. 10MM

12-1118

FEMORAL NAIL, L.34CM, DIAM. 11MM

12-1119

FEMORAL NAIL, L.36CM, DIAM. 11MM

12-1120

FEMORAL NAIL, L.38CM, DIAM. 11MM

12-1121

FEMORAL NAIL, L.40CM, DIAM. 11MM

12-1122

FEMORAL NAIL, L.42CM, DIAM. 11MM

12-1123

FEMORAL NAIL, L.44CM, DIAM. 11MM

12-1124

FEMORAL NAIL, L.46CM, DIAM. 11MM

12-1125

FEMORAL NAIL, L.34CM,DIAM.12MM

12-1126

FEMORAL NAIL, L.36CM,DIAM.12MM

12-1127

FEMORAL NAIL, L.38CM,DIAM.12MM

12-1128

FEMORAL NAIL, L.40CM,DIAM.12MM

12-1129

FEMORAL NAIL, L.42CM,DIAM.12MM

12-1130

FEMORAL NAIL, L.44CM,DIAM.12MM

12-1131

FEMORAL NAIL, L.46CM,DIAM.12MM

12-1132

FEMORAL NAIL, L.34CM,DIAM.13MM

12-1133

FEMORAL NAIL, L.36CM,DIAM.13MM

12-1134

FEMORAL NAIL, L.38CM,DIAM.13MM

12-1135

FEMORAL NAIL, L.40CM,DIAM.13MM

12-1136

FEMORAL NAIL, L.42CM,DIAM.13MM

12-1137

FEMORAL NAIL, L.44CM,DIAM.13MM

12-1138

FEMORAL NAIL, L.46CM,DIAM.13MM

12-1200

SCREW PLUG FOR FEMUR

JMF (T) Group Co.,Ltd. -group.com www.jmft -group.com (T) Grou G roup p Co C o.,Ltd Ltd. - Email: Email: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com

3

IMN

IM Implants

Locking bolt 5.5mm for Proximal Femur

12-1300

LOCKING BOLT, L.26MM, DIAM. 5.5MM

12-1301

LOCKING BOLT, L.28MM, DIAM. 5.5MM

12-1302

LOCKING BOLT, L.30MM, DIAM. 5.5MM

12-1303

LOCKING BOLT, L.32MM, DIAM. 5.5MM

12-1304

LOCKING BOLT, L.34MM, DIAM. 5.5MM

12-1305

LOCKING BOLT, L.36MM, DIAM. 5.5MM

12-1306

LOCKING BOLT, L.38MM, DIAM. 5.5MM

12-1307

LOCKING BOLT, L.40MM, DIAM. 5.5MM

12-1308

LOCKING BOLT, L.45MM, DIAM. 5.5MM

12-1309

LOCKING BOLT, L.50MM, DIAM. 5.5MM

12-1310

LOCKING BOLT, L.55MM, DIAM. 5.5MM

12-1311

LOCKING BOLT, L.60MM, DIAM. 5.5MM

12-1312

LOCKING BOLT, L.65MM, DIAM. 5.5MM

12-1313

LOCKING BOLT, L.70MM, DIAM. 5.5MM

12-1314

LOCKING BOLT, L.75MM, DIAM. 5.5MM

12-1315

LOCKING BOLT, L.80MM, DIAM. 5.5MM

12-1316

LOCKING BOLT, L.85MM, DIAM. 5.5MM

12-1317

LOCKING BOLT, L.90MM, DIAM. 5.5MM

12-1318

LOCKING BOLT, L.95MM, DIAM. 5.5MM

12-1319

LOCKING BOLT, L.100MM, DIAM. 5.5MM

Locking bolt 4.5mm for distal Femur / Proximal tibia / Supra Condylar

4

12-1350

L.26MM, DIAM. 4.5MM

12-1351

L.28MM, DIAM. 4.5MM

12-1352

L.30MM, DIAM. 4.5MM

12-1353

L.32MM, DIAM. 4.5MM

12-1354

L.34MM, DIAM. 4.5MM

12-1355

L.36MM, DIAM. 4.5MM

12-1356

L.38MM, DIAM. 4.5MM

12-1357

L.40MM, DIAM. 4.5MM

12-1358

L.45MM, DIAM. 4.5MM

12-1359

L.50MM, DIAM. 4.5MM

12-1360

L.55MM, DIAM. 4.5MM

12-1361

L.60MM, DIAM. 4.5MM

12-1362

L.65MM, DIAM. 4.5MM

12-1363

L.70MM, DIAM. 4.5MM

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

IM Implants

IMN

Tibia Nail

12-1400

TIBIA INTERLOCKING NAIL, L.28,0CM, DIAM. 9MM

12-1401

TIBIA INTERLOCKING NAIL, L.30,0CM, DIAM. 9MM

12-1402

TIBIA INTERLOCKING NAIL, L.31,0CM, DIAM. 9MM

12-1403

TIBIA INTERLOCKING NAIL, L.32,0CM, DIAM. 9MM

12-1404

TIBIA INTERLOCKING NAIL, L.33,0CM, DIAM. 9MM

12-1405

TIBIA INTERLOCKING NAIL, L.34,0CM, DIAM. 9MM

12-1406

TIBIA INTERLOCKING NAIL, L.35,0CM, DIAM. 9MM

12-1407

TIBIA INTERLOCKING NAIL, L.36,0CM, DIAM. 9MM

12-1408

TIBIA INTERLOCKING NAIL, L.38,0CM, DIAM. 9MM

12-1409

TIBIA INTERLOCKING NAIL, L.40,0CM, DIAM. 9MM

12-1410

TIBIA INTERLOCKING NAIL, L.28,0CM, DIAM. 10MM

12-1411

TIBIA INTERLOCKING NAIL, L.30,0CM, DIAM. 10MM

12-1412

TIBIA INTERLOCKING NAIL, L.31,0CM, DIAM. 10MM

12-1413

TIBIA INTERLOCKING NAIL, L.32,0CM, DIAM. 10MM

12-1414

TIBIA INTERLOCKING NAIL, L.33,0CM, DIAM. 10MM

12-1415

TIBIA INTERLOCKING NAIL, L.34,0CM, DIAM. 10MM

12-1416

TIBIA INTERLOCKING NAIL, L.35,0CM, DIAM. 10MM

12-1417

TIBIA INTERLOCKING NAIL, L.36,0CM, DIAM. 10MM

12-1418

TIBIA INTERLOCKING NAIL, L.38,0CM, DIAM. 10MM

12-1419

TIBIA INTERLOCKING NAIL, L.40,0CM, DIAM. 10MM

12-1420

TIBIA INTERLOCKING NAIL, L.28,0CM, DIAM. 10MM

12-1421

TIBIA INTERLOCKING NAIL, L.30.0CM,DIAM. 11MM

12-1422

TIBIA INTERLOCKING NAIL, L.31.0CM,DIAM. 11MM

12-1423

TIBIA INTERLOCKING NAIL, L.32.0CM,DIAM. 11MM

12-1424

TIBIA INTERLOCKING NAIL, L.33.0CM,DIAM. 11MM

12-1425

TIBIA INTERLOCKING NAIL, L.34.0CM,DIAM. 11MM

12-1426

TIBIA INTERLOCKING NAIL, L.35.0CM,DIAM. 11MM

12-1427

TIBIA INTERLOCKING NAIL, L.36.0CM,DIAM. 11MM

12-1428

TIBIA INTERLOCKING NAIL, L.38.0CM,DIAM. 11MM

12-1429

TIBIA INTERLOCKING NAIL, L.40.0CM,DIAM. 11MM

12-1430

TIBIA INTERLOCKING NAIL, L.28.0CM,DIAM. 12MM

12-1431

TIBIA INTERLOCKING NAIL, L.30.0CM,DIAM. 12MM

12-1432

TIBIA INTERLOCKING NAIL, L.31.0CM,DIAM. 12MM

12-1433

TIBIA INTERLOCKING NAIL, L.32.0CM,DIAM. 12MM

12-1434

TIBIA INTERLOCKING NAIL, L.33.0CM,DIAM. 12MM

12-1435

TIBIA INTERLOCKING NAIL, L.34.0CM,DIAM. 12MM

12-1436

TIBIA INTERLOCKING NAIL, L.35.0CM,DIAM. 12MM

12-1437

TIBIA INTERLOCKING NAIL, L.36.0CM,DIAM. 12MM

12-1438

TIBIA INTERLOCKING NAIL, L.38.0CM,DIAM. 12MM

12-1439

TIBIA INTERLOCKING NAIL, L.40.0CM,DIAM. 12MM

12-1500

SCREW PLUG FOR TIBIA & SUPRA CONDYLAR NAIL

JMF (T) Group Co.,Ltd. -group.com www.jmft -group.com (T) Grou G roup p Co C o.,Ltd Ltd. - Email: Email: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com

5

IMN

IM Implants

Locking bolt 4.5mm for distal tibia / Supra Condylar 12-1501

LOCKING SCREW, L.26MM DIAM 4.5MM

12-1502

LOCKING SCREW, L.28MM DIAM. 4.5MM

12-1503

LOCKING SCREW, L.30MM DIAM. 4.5MM

12-1504

LOCKING SCREW, L.32MM DIAM. 4.5MM

12-1505

LOCKING SCREW, L.34MM DIAM. 4.5MM

12-1506

LOCKING SCREW, L.36MM DIAM. 4.5MM

12-1507

LOCKING SCREW, L.38MM DIAM. 4.5MM

12-1508

LOCKING SCREW, L.40MM DIAM. 4.5MM

12-1509

LOCKING SCREW, L.45MM DIAM. 4.5MM

12-1510

LOCKING SCREW, L.50MM DIAM. 4.5MM

12-1511

LOCKING SCREW, L.55MM DIAM. 4.5MM

12-1512

LOCKING SCREW, L.60MM DIAM. 4.5MM

12-1513

LOCKING SCREW, L.65MM DIAM. 4.5MM

Supra Condylar Nail

12-1600

SUPRA CONDYLAR NAIL, 15CM X DIAM. 11MM

12-1601

SUPRA CONDYLAR NAIL, 20CM X DIAM. 11MM

12-1602

SUPRA CONDYLAR NAIL, 25CM X DIAM. 11MM

12-1603

SUPRA CONDYLAR NAIL, 28CM X DIAM. 11MM

12-1604

SUPRA CONDYLAR NAIL, 30CM X DIAM. 11MM

12-1605

SUPRA CONDYLAR NAIL, 15CM X DIAM. 12MM

12-1606

SUPRA CONDYLAR NAIL, 20CM X DIAM. 12MM

12-1607

SUPRA CONDYLAR NAIL, 25CM X DIAM. 12MM

12-1608

SUPRA CONDYLAR NAIL, 28CM X DIAM. 12MM

12-1609

SUPRA CONDYLAR NAIL, 30CM X DIAM. 12MM

12-1500

6

SCREW PLUG FOR TIBIA & SUPRA CONDYLAR NAIL

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

IM Instruments

IMN

Instruments

12-1700

SCREWDRIVER HEX. 3,5MM, SELF-HOLDING

12-1701

DIAMOND POINTED AWL

12-1702

STARTER AWL

12-1703

AWL

(T) Grou G roup p Co C o.,Ltd Ltd. - Email: Email: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com JMF (T) Group Co.,Ltd. -group.com www.jmft -group.com

7

IMN

IM Instruments

12-1704

REDUCTION GUIDE

12-1705

DEPTH GAUGE

12-1706

TWIST DRILL 3,5MM, LENGTH 220MM

12-1707

TWIST DRILL 4,5MM, LENGTH 220MM

12-1708

TWIST DRILL 5,5MM, LENGTH 220MM

12-1709

DRILL GUIDE 3,5MM FOR TIBIA / FEMUR

12-1710

DRILL GUIDE 4,5MM FOR TIBIA / FEMUR

12-1711

12-1712

8

DRILL GUIDE 5,5MM FOR TIBIA / FEMUR

DRILL SLEEVE ASSEMBLY, LONG, CONDYLAR

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

IM Instruments

12-1713

12-1714

12-1715

IMN

DRILL SLEEVE ASSEMBLY, SHORT, CONDYLAR

SUPRA CONDYLAR JIG AND NAIL IMPACTOR

FEMUR / TIBIA JIG AND NAIL IMPACTOR

(T) Grou G roup p Co C o.,Ltd Ltd. - Email: Email: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com JMF (T) Group Co.,Ltd. -group.com www.jmft -group.com

9

IMN

IM Instruments

12-1716

12-1717

12-1718

12-1719

12-1720

10

OPEN END WRENCH, SW 10/15

IMPACTOR / EXTRACTOR, CANNULATED

NAIL EXTRACTION DEVICE

GUIDE WIRE HOLDER, SELF LOCKING

SKIN PROTECTOR

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

IM Instruments

12-1721

GUIDE BUSH

12-1722

TROKAR, RADIOLUCENT

12-1723

12-1724

12-1725

IMN

HOMING DEVICE, DISTAL FEMUR

HOMING DEVICE, DISTAL TIBIA

DISTAL AIMING DEVICE

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

11

IMN

IM Instruments

12-1726

12-1727

GUIDE ROD F. REAMER,L.900MM,DIAM.4MM

12-1728

GUIDE ROD F. REAMER,L.900MM,DIAM.4MM,

12-1729

GUIDE ROD F. REAMER,L.900MM,DIAM.3MM,

12-1720

12

MEDULLARY EXCHANGE TUBE

SKIN PROTECTOR

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

Technique Femur

IMN

Surgical Technique Preparing the Canal and Inserting the Femoral Nail

5 cm

1

An incision of approximately 5 cm is carried out centered on the tip of the greater trochanter.

Access the medullary canal using the Diamond Pointed Awl (12-1701). The point of insertion should be in line with the pyriformis fossa, slightly medial to the tip of the greater trochanter.

Insert a standard Reaming Guide Wire (or Reduction-cumReaming Guide Wire) using the following steps –

2

3

• Insert the guide wire upto the fracture site • Check fracture reduction using the image intensifier • Insert the wire beyond the fracture site • Insert the wire upto the supracondylar region and check correct positioning in the center of the femoral canal.

Proceed to ream the femoral canal using sequential flexible reamers in steps of 0.5mm. Ensure AP and ML control of the reamer to avoid eccentric reaming. If comminution is present, reaming should be stopped at the fracture site and the reamer pushed past the fracture site, with the power drill in the “off ” position, till the reamer crosses the site of comminution. The last reamer used should be at least 1mm (ideally 1.5 – 2.0mm) higher than the planned nail diameter. It may be necessary to over-ream the proximal part of the canal 2.5 – 3.0mm higher than the planned nail diameter to accommodate the proximally strengthened part of the nail.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

13

IMN

Technique Femur

Selection of Nail length Prior to inserting the nail, the reaming guide wire should be exchanged for the Nailing guide wire (12-1729) using an Exchange Sleeve. Select nail length by measuring the length of the nailing guide wire outside the intramedullary canal (exposed length) from the point of entry and reducing the same from the total length of the wire.

4

• Add 5mm to arrive at the length of nail to be used. • Round off this figure to the next higher nail length available. In case of highly comminuted fractures, use X-ray measurements of the contralateral limb to arrive at the nail length to be used.

Nail Insertion Nail insertion is achieved using the following steps

5

6

Assemble the selected femur nail with the Femur/Tibia Jig cum Nail Impactor, complete (12-1715) by aligning the slots on the nail with the two prongs on the body of the instrument and tightening the threads on the Locking Bolt of the instrument with the internal threads on the nail.

7

14

Disassemble the Driver for Jig Assembly by unthreading it from the Main Body of the Jig to expose the proximal end of the Nail Locking Bolt.

Using the Double Ended Spanner (12-1716), tighten the Nail Locking Bolt, so that the Femur Nail is securely fastened. Important: Excessive force must not be used to tighten the nail locking bolt. A quarter-turn with the spanner is normally sufficient to secure the nail following manual tightening of the locking bolt.

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

Technique Femur

8

IMN

Reassemble the Driver for Jig Assembly to the main body of the instrument.

Insert the nail over the nailing guide wire and introduce the nail by hand as far as possible.

9

10

Important: While insertion, the tip of the nail may ‘catch’ on the medial cortex of the medullary cavity if the proximal part of the nail is not slightly pushed in towards the patient. If this happens, it is essential that hammering is not carried out as a fracture of the femoral shaft or bending of the nail may result.

Reassemble the Driver for Jig Assembly to the main body of the instrument.

Use the InLine Impaction/Extraction Ram (12-1717) to impact the Nail-Jig assembly for final impaction. If necessary, the guide wire must be held to prevent backing out.

11

Note: Direct hammering on any part of the Jig assembly should be avoided at all costs as this will cause the Jig to distort and destroy the accuracy of the guiding holes. Impaction and Extraction should be carried out only using the InLine Impaction/Extraction Ram.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

15

Technique Femur

IMN

Distal Locking with Screws Distal locking is performed in the conventional mode with distal screws. The standard free hand technique for distal locking is recommended. Distal aiming devices including the Guide Bush (12-1721), Aiming Trocar (12-1722), Homing Device, Femur (12-1723), Homing Device, Tibia (12-1724) and Distal Aiming Device with Fibre Handle (12-1725) are available in the instrumentation to assist in the distal locking process. Different types of distal locking screws are available with the system and are described below: • Locking Screw 4.5mm, self-tapping: This screw requires both cortices to be drilled with a 3.5mm drill bit and over-drilling of the near cortex with a 4.5mm drill bit. The 4.5mm shaft with distal threads provides higher resistance to shear loading. The threads on the screw head enable this screw to be securely engaged with the Hex Screwdriver with Sleeve while insertion. • Tibial Locking Screw 4.5mm, self tapping: This screw while designed for the tibia may also be used for distal femoral locking. Faster insertion is possible as this screw is designed for direct insertion following 3.5mm drilling (both cortices). Insertion is with a standard Hex Screwdriver (3.5mm a/f).

Proximal Locking The femur nails allow proximal locking in three configurations. The steps to be followed to achieve proximal locking in each of these configurations are described below.

The 130° Downward Lock Engaging the dense trabecular bone of the medial femur, this is the preferred locking option when allowed by the fracture configuration. The additional benefit of this locking option is that prox mal locking can be achieved by slightly extending the main nail insertion incision without creating a second incision for the proximal lock. Proximal locking with the 130°, downward locking screw is achieved with the following steps:

12

16

Ensure that the Jig cum Nail Impactor is securely engaged with the implanted nail and is correctly oriented with the Locking Arm oriented lateral to the nail. Extend the nail insertion incision as necessary to achieve insertion of the Drill Guide for proximal locking, upto bone.

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

Technique Femur

13

Insert the Drill Guide, 3.5mm (12-1709) into the 130°, downward locking hole and advance it to bone.

14

15

IMN

Drill a 3.5mm hole with the 3.5mm Drill Bit (121706) through the Drill Guide through both cortices.

Exchange the Drill Guide, 3.5mm with the Drill Guide, 5.5mm (12-1711).

16

Drill a 5.5mm hole with the 5.5mm Drill Bit (121708) only through the proximal cortex.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

17

IMN

Technique Femur

17

18

Insert the Depth Gauge (12-1705) to read off the length of locking screw required.

Assemble the Hex Screwdriver with Sleeve (12-1700), to the selected locking screw by rotating the Sleeve clockwise to engage the proximal threads on the locking screw.

19

18

Insert the locking screw through the 130°, downward guide hole on the Jig cum Nail Impactor by first advancing it through the near cortex and the nail hole without rotation and then rotating clockwise to engage the self-tapping distal threads in the distal cortex.

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

Technique Femur

IMN

The Transverse Lock The transverse lock is required in higher proximal fractures where the proximal end of the fracture would extend too close to the tip of the 130°, downward locking screw. To carry out the transverse lock, follow the steps as below:

20

21

Ensure that the Jig cum Nail Impactor is securely engaged with the implanted nail and is correctly oriented with the Locking Arm oriented lateral to the nail. Carry out an incision as necessary to achieve insertion of the Drill Guide for proximal locking, upto bone.

Insert the Drill Guide, 3.5mm (12-1709) into the transverse locking hole and advance it to bone. Complete the process of creating the tract for the transverse locking screw and prepare the screw using the same sequence of steps as described earlier

22

Insert the locking screw through the transverse guide hole on the Jig cum Nail Impactor by first advancing it through the near cortex and the nail hole without rotation and then rotating clockwise to engage the self-tapping distal threads with the distal cortex.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

19

IMN

Technique Femur

The 130° Upward Lock with Miss-a-Nail The 130° Upward Lock with Miss-a-Nail option is an effective solution in cases where a femoral shaft fracture co-exists with an ipsilateral intra or extra-capsular fracture of the femoral neck. This locking option is achieved through the following steps: Ensure that the Jig cum Nail Impactor is securely engaged with the implanted nail and is correctly oriented with the Locking Arm oriented lateral to the nail. Carry out an incision as necessary to achieve insertion of the Drill Guide for proximal locking, upto bone.

23

Insert the Drill Guide, 3.5mm (12-1709) into the transverse locking hole and advance it to bone. Complete the process of creating the tract for the upward locking screw and prepare the screw using the same sequence of steps as described earlier.

24

Insert the locking screw through the transverse guide hole on the Jig cum Nail Impactor by first advancing it through the near cortex and the nail hole without rotation and then rotating clockwise to engage the self-tapping distal threads with the distal cortex.

The Miss-a-Nail Screws Insert the locking screw through the transverse guide hole on the Jig cum Nail Impactor by first advancing it through the near cortex and the nail hole without rotation and then rotating clockwise to engage the self-tapping distal threads with the distal cortex. The instrumentation is designed to allow the placement of two Miss-a-Nail screws anterior to the nail and oriented upwards into the femoral neck. Proper placement of the nail in the canal verified by image intensifier views to confirm expected placement

20

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

Technique Femur

IMN

Position and lock the Miss-a-Nail attachment on the anterior surface of the locking arm (Guide Bar).

25

The Miss-a-Nail holes are positioned to accept two 5.5mm locking screws placed anterior to the nail. Use the standard procedure described earlier to place one or two 5.5mm locking screws, as appropriate into the neck of the femur.

26

Finally, the Locking Cap is threaded onto the proximal end of the nail by engaging the threads of the Cap with the internal threads of the implanted nail. A standard 3.5 a/f screwdriver is used.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

21

IMN

Technique Tibia

Preparing the Canal and Inserting the Tibia Nail

1

A surgical incision of approximately 5 cm vertically and centrally to the tibial plateau extending distally is carried out. The patellar tendon is either cut centrally or retracted laterally. Access the diaphyseal canal using the Diamond Pointed Awl (12-1701). The proximal insertion point selected should be less than 1 cm distal to the anterior margin of the tibial plateau. If the insertion point is too distal, damage to posterior cortical bone could result.

Insert a standard Reaming Guide Wire (or Reduction-cum-Reaming Guide Wire) using the following steps – • Insert the guide wire upto the fracture site • Check fracture reduction using the image intensifier • Insert the wire beyond the fracture site • Insert the wire upto the 1 cm proximal to the ankle joint

2

3

Proceed to ream the tibial canal using sequential flexible reamers in steps of 0.5mm. Ensure AP and ML control of the reamer to avoid eccentric reaming. If comminution is present, reaming should be stopped at the fracture site and penetration continued with the power drill in the “off ” position, till the reamer crosses the site of comminution. The last reamer used should be 1.5 – 2.0mm higher than the planned nail diameter. It may be necessary to over-ream the proximal part of the canal (at least the cortical) 2.5 – 3.0mm higher

Selection of Nail length

4

Prior to inserting the nail, the reaming guide wire should be exchanged for the Nailing guide wire using an Exchange Sleeve. Tibial nails in the system are available in increments of 10mm to facilitate easy availability of the closest length of nail required. Select nail length by measuring the length of the nailing guide wire outside the intramedullary canal (exposed length) from the point of entry and reducing the same from the total length of the wire. • Add 5mm to arrive at the length of nail to be used. • Round off this figure to the next higher nail length available. In case of highly comminuted fractures, use X-ray measurements of the contralateral limb to arrive at the nail length to be used.

22

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

Technique Tibia

IMN

Nail Insertion (Nail insertion is achieved using the following steps)

5

6

Assemble the selected tibia nail with the Femur/Tibia Jig cum Nail Impactor, complete by aligning the slots on the nail with the two prongs on the body of the instrument and tightening the threads on the Locking Bolt of the instrument with the internal threads on the nail.

7

8

Disassemble the Driver for Jig Assembly by unthreading it from the Main Body of the Jig to expose the proximal end of the Nail Locking Bolt.

Using the Double Ended Spanner (12-1716), tighten the Nail Locking Bolt, so that the Tibia Nail is securely fastened. Important: Excessive force must not be used to tighten the nail locking bolt. A quarter-turn with the spanner is normally sufficient to secure the nail following manual tightening of the locking bolt.

Reassemble the Driver for Jig Assembly to the main body of the instrument.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

23

IMN

Technique Tibia

9

Assemble the Tibial Locking Extension by tightening the Locking Bolt For Tibial Locking Extension, first by hand and then using the Double Ended Spanner (12-1716).

10

11

24

Insert the nail over the nailing guide wire and introduce the nail by hand as far as possible.

If impaction is necessary to further drive in the nail, thread the Nail Impaction/Extraction Assembly (12-1717) to the proximal end (Driver for Jig Assembly) of the Jig.

JMF (T) (T) Grou G pC Co.,Ltd Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j jmft ft-group.com Group Co.,Ltd. www.jmft

Technique Tibia

12

IMN

Use the InLine Impaction/Extraction Ram (12-1717) to impact the Nail-Jig assembly for final impaction. If necessary, the guide wire must be held to prevent backing out. Note: Direct hammering on any part of the Jig assembly should be avoided at all costs as this will cause the Jig to distort and destroy the accuracy of the guiding holes. Impaction and Extraction should be carried out only using the InLine Impaction/Extraction Ram.

Image intensifier views may be taken to confirm correction positioning of the nail.

Distal Locking with screws Distal locking is performed in the conventional mode with distal screws. The standard free hand technique for distal locking is recommended. Distal aiming devices including the Guide Bush (12-1721), Aiming Trocar (12-1722), Homing Device, Femur (12-1723), Homing Device, Tibia (12-1724) and Distal Aiming Device with Fibre Handle (12-1725) are available in the instrumentation to assist in the distal locking process. Different types of distal locking screws are available, and are described below: • Locking Screw 4.5mm, self-tapping: This screw requires both cortices to be drilled with a 3.5mm drill bit and over-drilling of the near cortex with a 4.5mm drill bit. The 4.5mm shaft with distal threads provides higher resistance to shear loading. The threads on the screw head enable this screw to be securely engaged with the Hex Screwdriver with Sleeve while insertion. • Tibial Locking Screw 4.5mm, self tapping: This screw while designed for the tibia may also be used for distal femoral locking. Faster insertion is possible as this screw is designed for direct insertion following 3.5mm drilling (both cortices). Insertion is with a standard Hex Screwdriver (3.5mm a/f).

Proximal Locking

Proximal locking with tibial nails is achieved with two proximal locking screws oriented at 45° to the A-P plane as illustrated. The 45°, orientation provides two important benefits: • The distal threads of both proximal locking screws engage in the dense postero-medial and postero-lateral cortices of the tibia. This provides more secure holding when compared with medio-lateral locking screws • The inclined drilling that is required for placement of these screws is safer as it eliminates the risk to posterior neurovascular structures associated with antero-posterior drilling for A-P screws Tibial locking is performed with 4.5mm Tibial Locking Screws with low profile screw heads. These screws are self-tapping with a core diameter appropriate for direct insertion following drilling with a 3.5mm drill bit.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

25

IMN

Technique Tibia

13

14

26

Make a small incision as necessary to achieve insertion of the Drill Guide for proximal locking, into the appropriate locking hole, upto bone.

Insert the Drill Guide, 3.5mm (12-1709) into the proximalmost locking hole and advance it to bone.

15

16

Ensure that the Jig cum Nail Impactor is securely engaged with the implanted nail and is correctly oriented.

Drill a 3.5mm hole with the 3.5mm Drill Bit (12-1706) through both cortices.

Insert the Depth Gauge (12-1705) to read off the length of locking screw required.

JMF (T) (T) Grou G Group pC Co.,Ltd Co.,Ltd. Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j www.jmft jmft ft-group.com

Technique Tibia

17

18

IMN

Insert the selected Tibial Locking Screw with the Hex Screwdriver 3.5 a/f. Complete the proximal locking procedure for the second proximal screw using the same sequence of steps as described earlier.

Finally, the Locking Cap is threaded onto the proximal end of the nail by engaging the threads of the Cap with the internal threads of the implanted nail. A standard 3.5 a/f screwdriver is used.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

27

IMN

Technique Supracondylar

Supracondylar Nailing The Supracondylar Nail is a non-slotted smooth, cylindrical nail with proximal and distal holes. The 8° angle allows for better seating of the implant within the femoral canal and also allows percutaneous insertion without interfering with the patella or patellar tendon. The proximal (insertion) end of the nail features internal threads, which securely couple with the instrumentation and also allow engagement of a threaded locking cap.

Point of entry

The point of entry is located, just anterior to the insertion of the posterior cruciate ligament. This point is identified as the co-ordinate at the junction of the antero-posterior line drawn through the deepest part of the trochlear groove and the medio-lateral line connecting the two epicondyles.

Incision Nailing can be done either through a formal open approach or through a percutaneous approach. For the formal open approach, a medial para-patellar incision is taken and the patella is dislocated laterally. The percutaneous approach is done through a 2 cm incision distal to the inferior pole of the patella and medial to the patellar tendon. The infra-patellar fat pad is retracted, a steinman pin is inserted and the point of entry is localized with the help of a C-arm image intensifier.

Preparing the canal

1

28

Make the initial entry with a Diamond Pointed Awl (12-1701). Take care to ensure that the direction of the tract is in line with the medullary canal of the femur.

JMF (T) (T) Grou G Group pC Co.,Ltd Co.,Ltd. Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j www.jmft jmft ft-group.com

Technique Supracondylar

2

IMN

Using the Starter Awl (12-1702), enlarge the canal to match the dimensions of the distal part of the nail.

Insert a standard reaming guide wire (or reductioncum-reaming guide wire) using the following steps –

3

• Insert the guide wire upto the fracture site • Check fracture reduction using the image intensifier • Insert the wire beyond the fracture site to an insertion depth of approximately 250 mm and check correct positioning of the wire in the center of the femoral canal

4

Proceed to ream the femoral canal using sequential flexible reamers in steps of 0.5mm. Ensure AP and ML control of the reamer to avoid eccentric reaming. If comminution is present, reaming should be stopped at the fracture site and the reamer pushed past the fracture site, with the power drill in the “off ” position, till the reamer crosses the site of comminution. The last reamer used should be at least 1mm (ideally 1.5 – 2.0mm) higher than the planned nail diameter. It may be necessary to overream the proximal part of the canal 2.5 – 3.0mm higher than the planned nail diameter to accommodate the proximally strengthened part of the nail.

Selection of Nail Length

5

Prior to inserting the nail, the reaming guide wire should be exchanged for the Nailing guide wire using an Exchange Sleeve. Available lengths are 150mm and 200mm. Nail length selection is based on pre-operative planning to ensure that there is a distance of at least 50mm between the fracture site and the nearest proximal locking screw.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

29

IMN

Technique Supracondylar

Nail insertion

6

Disassemble the Driver for Jig Assembly, supracondylar by unthreading it from the main body of the jig to expose the proximal end of the Nail Locking Bolt.

7

8

Using the Double Ended Spanner (12-1716), tighten the Nail Locking Bolt, so that the Supracondylar Nail is securely fastened. Important: Excessive force must not be used to tighten the nail locking bolt. A quarter-turn with the spanner is normally sufficient to secure the nail following manual tightening of the locking bolt.

9

30

Assemble the selected supracondylar nail with the Supracondylar Jig-cum-Nail Impactor (12-1714) by aligning the slots on the nail with the two prongs on the body of the instrument and tightening the threads on the Locking bolt of the instrument with the internal threads on the nail. Ensure that the apex of the angle in the nail faces anterior-wards for correct nail placement.

Reassemble the Driver for Jig assembly, supracondylar to the main body of the instrument.

JMF (T) (T) Grou G Group pC Co.,Ltd Co.,Ltd. Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j www.jmft jmft ft-group.com

Technique Supracondylar

10

IMN

Insert the nail over the nailing guide wire and introduce the nail by hand as far as possible. If some impaction is found to be necessary, thread the Nail Impaction/Extraction Assembly (12-1717) to the proximal end (Driver for Jig Assembly) of the Jig. Note: Direct hammering on any part of the Jig assembly should be avoided at all costs as this will cause the Jig to distort and destroy the accuracy of the guiding holes. Impaction and Extraction should be carried out only using the InLine Impaction/Extraction Ram.

11

The insertion Jig cum nail Impactor exactly matches the outer diameter of the nail. This allows complete nail insertion without mechanical impedance. A groove located on the Jig body enables control of insertion depth (aligning the groove with the distal articular surface of the lateral femoral condyle ensures correct depth of nail insertion.

Locking of the supracondylar nail It is recommended that proximal locking be carried out first and fracture reduction and nail position confirmed before carrying out the distal lock. Proximal locking is carried out using the Drill sleeve assembly, long (12-1712). The Guide Bar of the Jig cum nail Impactor features four proximal holes. The two most proximal holes are used to lock the 200mm nail. The next two holes are used to lock the 150mm nail.

Use the following steps to carry out proximal locking after making an appropriate incision –

Insert the Drill sleeve assembly,Long (12-1712) into the appropriate (more proximal, guide hole on the Guide Bar depending on the length of the selected nail).

12

Tap the Trocar lightly to make an indentation on the surface of the bone. This allows better engagement of the tip of the drill bit. Withdraw the Trocar leaving the rest of the assembly in place.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

31

IMN

Technique Supracondylar

Insert a long 3.5mm drill bit (at least 220mm length drill bit) through the Drill sleeve assembly and drill a 3.5mm hole through both cortices.

13

Withdraw the Inner sleeve, long leaving the Outer sleeve in place in the guiding hole. Insert a long 5.5mm drill bit (at least 220mm length drill bit) through the Outer sleeve and drill a 5.5mm hole through the near cortex only. The Outer sleeve may now be withdrawn

14

Insert the Depth Gauge (12-1705) to read off the length of locking screw required

15

16

32

Assemble the Hex Screwdriver with Sleeve (12-1700) to the selected locking screw by rotating the Sleeve clockwise to engage the proximalthreads on the locking screw.

Insert the locking screw through the guide hole previously used for drilling by first advancing it through the near cortex and the nail hole without rotation and then rotating clockwise to engage the self-tapping distal threads in the far cortex. The same steps are used to complete proximal locking using the second locking screw. Nail alignment and fracture reduction are now re-confirmed using an image intensifier. Distal locking is now carried out, using the Drill Sleeve Assembly,Short (12-1713) using two screws following the same steps to complete insertion of the screws as described earlier.

JMF (T) (T) Grou G Group pC Co.,Ltd Co.,Ltd. Ltd. - EEmail: mailil: info@jmft inf i fo@j @jmft ft-group.com - Web: W b www.j www.jmft jmft ft-group.com

Technique Supracondylar

IMN

The Threaded Locking Cap

17

It is recommended that a threaded locking cap be screwed in to the distal tip of the nail using a standard large screwdriver (3.5mm a/f). The locking cap closes the open end of the nail preventing bony in-growth, which makes eventual nail removal an easier procedure.

JMF (T) (T) Grou G roup p Co C o.,Ltd Ltd. - Ema Email: il: info@jmft info@ info@jmft jmft-grou group p.com com - Web Web:: www w ww.jmft jmft-grou group p.com com Group Co.,Ltd. -group.com www.jmft -group.com

33

Distributed by :

01-0002 Rev. 1.0.1

JMF (T) Group Co.,Ltd. 75/74 Moo 11, Paholyothin Rd., Klongnueng, Klongluang, Pathumthani 12120 Thailand

Tel.: +66 (0)2 529 64 30 Fax.: +66 (0)2 529 64 31 Email: [email protected] Web: www.jmft-group.com