Nite Tibial Nail Surgical Technique Nite Surgical Technique

Special thanks to Contributing Surgeons, Yalkın ÇAMURCU, MD, Department of Orthopedics and Traumatology Medical Faculty of Erzincan University Erzincan, Turkey Mehmet Cenk Cankuş, MD, FEBOT Department of Orthopedics and Traumatology Medical Faculty of Sanko University Gaziantep, Turkey

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TABLE OF CONTENTS Nite Tibial Nail NAIL REMOVAL

Claw Technology Dunitech leads innovational systems, and aims to supply options for the surgeons to excel at their expertise. Claws Six retractable Claws are designed to penetrate the cortex, and provide exceptional axial and rotational stability. are a novelty solution on distal locking systems designed to support the orthopedic trauma community. Claws are titanium pins that act as anchors to provide a stable fixation, as well as other superior operative parameters. Claws are made from titanium, and mechanically deploy from within the nail. Claws penetrate through the cancellous bone, and anchor...

Nite Tibial Nail Specifications reliably retractable! All Claws were successfully retracted after every test. Conventional systems are subjected to screw breakage, screw head wear and drill bit breakage that may prevent the nail to be removed. Dunitech Claws are deployed within the nails from precise holes in a tight fit, preventing empty spaces for bone ingrowth. increment ● Distal Claw Maximum Span: 38 mm ● Compression Range: 7 mm ● End Cap Length: 0 mm to 10 mm in 5 mm Rotational Stability increments Internal thread to secure the cap to the Cumulative Rotation(deg) Rotational Stability In...

Nite Tibial Nail Indications ● Proximal extra-articular fracture ● Open and closed fractures of the tibial shaft ● Pathologic / impending pathologic fractures ● Malunions / nonunions ● In a leg with a total knee implant. ● Fractures of the distal third. The following conditions may present an increased risk of implant failure. This list is not meant to be comprehensive. Physicians should use their clinical judgement when determining the appropriate implant and approach for a given patient. ● Infection ● Incomplete fusion of the epiphysis ● Cognitive and/or physical impairment that would lead...

Surgical Technique

1. Patient Positioning and Fracture Reduction INSTRUMENTS FOT REMOVING THE NAIL ● Place the patient in the supine position according to surgeon preference on a fracture or other radiolucent table with the knee hyperflexed (>90°). A triangle may be used to stabilize the limb during the surgery (Fig-1). Alternatively, the patient can be placed supine with the limb hung over the edge of Nite Entry Reamer (N04-0030) the table or in a traction table with a bump beneath the distal femur to flex the knee. Note: 4 The bump or triangle should be placed beneath the distal femur to reduce the risk of vascular...

4. Proximal Reaming INSTRUMENTS: Tissue Protector (N01-0150) Option 1: Trocar Tip Guide Wire Nite Entry Reamer (N04-0030) Ball Tip Guide Wire 2 mm x 900 mm (N01-0290), for Nite 9 nd 10 mm 2 mm Guide Wire Sheath (N01-0300), for Nite 9 and 10 mm Trocar Tip Guide Wire 3 mm x 600 mm (N01-0250) Ball Tip Guide Wire 3 mm x 900 mm (N01-0270), for Nite 11 mm ● Advance the 3 mm Trocar Tip Guide Wire through the entry point and into the proximal tibia with the help of a powered driver to a depth of 8 mm to 10 mm. 3 mm Guide Wire Sheath (N01-0280), for Nite 11 mm Pin Puller (N01-0080) ● The wire should be...

INSTRUMENTS FOR DISTAL REAMING 5. Determining the Nail Length INSTRUMENTS: Nite Radiographic Claw Template – 9 mm and 10 mm (N04-0080), for Nite 9 mm and 10 mm Nite Radiographic Claw Template – 11 mm (N04-0090), for Nite 11 mm Nite Radiographic Claw Template 9-10 mm (N04-0080) Nite Radiographic Claw Template-11 mm (N04-0090) ● Confirm that the fracture is well reduced and place the appropriate Nite Radiographic Claw Template over the affected leg. Use N04-0080 for nails with distal diameter of 9 mm or 10 mm and N04-0090 for nails with distal diameters of 11 mm. The template shows approximately...

INSTRUMENTS FOR TARGET GUIDE ASSEMBLY AND NAIL INSERTION INSTRUMENTS: Dunitech Intramedullary Reamer Set (INST-01-002) Drill Sleeve (N01-0120) Guide Wire Pusher (N01-0060) ● Confirm that the fracture is well reduced. Starting from 8.5 mm Reamer Cutter Head, ream until the desired depth with a steady pressure (Fig-11). By each pass, increase the diameter of the Reamer Cutter Head in 0.5 mm increments. Use the Guide Wire Pusher to keep the guide wire in place. If the sheath comes out with the reamer, insert it back before starting the next pass. Screw Sleeve (N01-0130) Nite Handle-Nail Connector...

Nite Handle-Nail Connector Screw (N04-0070) Handle-Arm Connector Screw (N01-0140) Nite Guide Handle (N04-0060) Screw Sleeve (N01-0130) Drill Sleeve (N01-0120) ● Mate the desired nail to the Nite Guide Handle. Ensure that the reference line on the nail is aligned with the corresponding line on the Guide Handle. Pass the HandleNail Connector Screw and use the 7 mm Hex Driver to secure it to the nail (Fig-13). Ensure that the connection is tight before proceeding. ● Before inserting the nail check the nail’s holes are correctly aligned to the holes of the Guide Arm. ● Mate the Nite Guide Arm with...

INSTRUMENTS FOR NAIL CLAWS DEPLOYMENT INSTRUMENTS: Impactor (N01-0070) - Optional Nite Claw Deployment Driver (N04-0020) Note: 4 If the Guide Wire Sheath has not been removed, it has to be removed in before the insertion of the nail (Fig-12). If a traditional ball tip guide wire was used, it must be exchanged for a smooth guide wire. Its tip won’t pass through the nail. ● Pass the nail over the guide wire, through the incision and into the bone. With steady pressure and gentle rotation movements, advance the nail (Fig-16). Monitor closely with the help of image intensifier the passage of the...