Global Advanced Tibia Nailing Instruments Name 2025 Top 6 Innovations

Distal Tibial intramedullary Nail (DTN)

Suprapatellar Approach Tibial Intramedullary Nail

Expert Tibia intramedullary Nail

1.Proximal Oblique Cut

Anterior oblique cutting in proximal end prevents irritation to patellar ligament.

2. Advanced Locking Design

Advance proximal locking design increases the desired stability for the proximal fragment.

3. Distal Oblique Lock

Distal oblique locking option to prevent soft tissue damage and increase stability of the distal fragment.

4. Double Thread Screw

Locking screw designed with double lead thread for easier insertion.

Locking Mechanism

Locking design for stronger fixation, reduce postoperative fragment dislocation.

Multi-point Support

Multi points of fixation provide angular stability and stable support for tibial palteau.

Compression Phases

The device features an adaptive adjustment function, with its morphological changes shown in the illustrations under both pre-compression (loose state) and post-compression (tightly fitted) conditions.

Proximal-Distal Fixation

Multi fixation method from proximal and distal, indicate ultimate proximal and distal tibial fractures.

Flat Design for Easy Insertion

The distal end of the main nail has a flat design, facilitating easy insertion into the medullary cavity.

Angular Locking Screws

Two angular locking screws at the proximal end prevent rotation and displacement of the fracture segment.

Anatomical Curvature

A special anatomical curvature ensures the main nail is optimally positioned within the medullary cavity.

Intersecting Angle Locking Screws

Three intersecting angle locking screws at the distal end provide effective support and fixation.

Versatility:

Suitable for most tibial shaft fractures (midshaft and some distal/proximal fractures), whereas other types (e.g., DTN or Expert Nail) are designed for specific anatomical regions or complex fractures.

Mature Surgical Technique:

The standard approach (parapatellar or transpatellar) follows a well-established procedure with a lower learning curve, whereas specialized approaches (e.g., suprapatellar) require additional technical training.

Cost-Effectiveness:

Compared to specialized nails like the Expert Nail or DTN, standard tibial intramedullary nails are typically more affordable, making them suitable for routine cases.

Broad Implant Compatibility:

Compatible with universal instrumentation (e.g., locking screws, targeting devices), whereas specialized nails (e.g., Expert Nail with multi-directional locking systems) may require proprietary tools.

1. Preoperative Preparation

Imaging Evaluation: Preoperative X-ray/CT to confirm fracture type, medullary canal diameter and length, with measurement of contralateral tibia as reference.

Positioning: Supine position with knee flexion 90°-120° and slight hip adduction (to reduce patellar tendon tension). A triangular radiolucent frame may support the popliteal fossa for traction.

Sterile Draping: Standard limb sterilization and draping, ensuring C-arm mobility.

2. Fracture Reduction

Closed Reduction Techniques

Manual Traction: Assistant applies longitudinal traction while surgeon palpates tibial crest and anteromedial surface to adjust alignment (length, rotation, angulation).

Instrument-Assisted:

• Joystick Technique: Schanz screws inserted into proximal/distal fragments for lever reduction.

• Percutaneous Clamping: Pointed reduction forceps for oblique/spiral fractures.

• Distractor: Large distractor placed coronally (proximal Schanz screw parallel to tibial plateau, distal pin in talus or distal tibia) to maintain length.

3. Entry Point Localization

Landmarks:

• Entry point 1cm distal to anterior tibial plateau edge, aligned with medullary axis.

• Fluoroscopic confirmation: AP view aligns with tibial crest, lateral view parallels tibial axis.

Opening Instruments:

• Cannulated drill over guidewire (with protective sleeve) or curved solid awl.

• Hand reamers (6-8mm) for old fractures with canal occlusion.

4. Guidewire Insertion & Reaming

Guidewire Placement: Ball-tipped guidewire bent 10-15mm at tip for fracture passage. Fluoroscopic confirmation at distal physeal scar (ankle center).

Reaming Protocol:

• Flexible reamers starting at 8mm, incrementing 0.5mm until cortical "chatter" (typically 1-1.5mm > nail diameter).

• Note: Intermittent withdrawal clears debris; avoid thermal necrosis.

5. Nail Insertion

Length Determination:

• Intraoperative measurement: Guidewire overlap method or fluoroscopic ruler (entry point to ankle joint).

• Ensure nail tip reaches physeal scar without proximal protrusion.

Insertion Technique:

• Hand-advance over guidewire; adjust reduction if resistance occurs.

• Maintain reduction during passage for distal fractures.

6. Interlocking Screw Fixation

Sequence Strategy

• Length-stable fractures: Proximal locking first (single screw allows dynamization).

• Length-unstable/comminuted fractures: Distal locking first followed by "backslap" to compress.

Proximal Locking

• ≥2 screws via aiming device (multidirectional for proximal fractures).

Distal Locking

• Fluoroscopic technique: Central beam perpendicular to screw holes ("perfect circle"), percutaneous drilling.

• ≥2 screws for distal fractures (may combine AP/oblique orientations).

7. Final Procedures

End Cap: Optional insertion (prevents bony ingrowth), ensure no joint protrusion.

Wound Closure: Layered patellar tendon repair with loose subcutaneous sutures.

8. Postoperative Management

Early Rehabilitation:

• Limb elevation; monitor for compartment syndrome within 24hrs.

• Initiate active joint mobilization (ankle pumps, knee flexion) on POD 1-2.

Weight-Bearing Protocol:

• Partial weight-bearing for 6 weeks (adjusted per stability), progressing to full when callus appears.

Follow-Up: Clinical/radiological evaluation at 2, 6, and 12 weeks.