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)TOFFERSGUIDANCETHATYOUSHOULDHEEDBUTASWITHANYSUCHTECHNICALGUIDEEACHSURGEONMUSTCONSIDERTHE
PARTICULARNEEDSOFEACHPATIENTANDMAKEAPPROPRIATEADJUSTMENTSWHENANDASREQUIRED

!WORKSHOPTRAININGISREQUIREDPRIORTOFIRSTSURGERY


5" # - &
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 )NTRODUCTION 
 )MPLANT&EATURES 
 )NSTRUMENT&EATURES 
 2EFERENCES 
 )NDICATIONS 
 0RE OPERATIVE0LANNING 
 /PERATIVE4ECHNIQUE 
 0ATIENT0OSITIONINGAND&RACTURE2EDUCTION 
 )NCISION 
 %NTRY0OINT 
 5NREAMED4ECHNIQUE 
 2EAMED4ECHNIQUE 
 .AIL3ELECTION 
 .AIL)NSERTION 
 'UIDED,OCKING-ODEVIA4ARGET$EVICE 
 &REEHAND$ISTAL,OCKING 
 %ND#AP)NSERTION 
 .AIL2EMOVAL 
 "LOCKING3CREW4ECHNIQUEOPTIONAL 
/RDERING)NFORMATION )MPLANTS 
/RDERING)NFORMATION )NSTRUMENTS 


*/530%6$5*0/


*/530%6$5*0/ 
*.1-"/5
'&"563&4

4HE 3© .AILING 3YSTEM REPRESENTS THE LATEST AND 4HE 3© 4IBIAL .AIL 4X IS THE REALIZATION OF SUPERIOR
MOST COMPREHENSIVE DEVELOPMENT OF THE ORIGINAL BIOMECHANICAL INTRAMEDULLARY STABILIZATION USING SMALL
INTRAMEDULLARYPRINCIPLESPRESENTEDBY0ROF'ERHARD CALIBERSTRONGCANNULATEDIMPLANTSFORINTERNALFIXATION
+àNTSCHERIN OFTHE4IBIA

3TRYKER 4RAUMA HAS CREATED A NEW GENERATION LOCKING 4HE3©4IBIAL.AIL4XMAYBEUSEDFORVERYPROXIMAL

NAIL SYSTEM BRINGING TOGETHER ALL THE CAPABILITIES AND ANDVERYDISTALFRACTURESFEATURINGTWOOBLIQUEANDONE
BENEFITS OF SEPARATE NAILING SYSTEMS TO CREATE A SINGLE -,PROXIMALHOLESFORSTATICLOCKINGANDDISTAL-,
INTEGRATED SURGICAL RESOURCE FOR FIXATION OF LONG BONE
FRACTURES 
4HE3©4IBIAL.AIL4XOFFERSTHEFOLLOWINGADVANTAGES
!0-, LOCKINGHOLES
.OTE4HE MOST DISTAL HOLE IS CENTERED AT MM FROM
THETIPOFTHENAILTOBETTERADDRESSHARDTOREACHDISTAL
FRACTURES
#OMMON MM CORTICAL SCREWS SIMPLIFY THE SURGICAL
PROCEDUREANDPROMOTEAMINIMALLYINVASIVEAPPROACH
s &ULLY 4HREADED ,OCKING 3CREWS ARE AVAILABLE FOR
REGULARLOCKINGPROCEDURES
)MPORTANT4HE MM 3©4IBIAL .AIL4X CAN ONLY BE
LOCKED DISTALLY WITH MM &ULLY 4HREADED 3CREWS !S
4HROUGH THE DEVELOPMENT OF A COMMON STREAMLINED WITHALLDIAMETERSOFTHE3©4IBIAL.AIL4XMM&ULLY
AND INTUITIVE SURGICAL APPROACH BOTH IN PRINCIPLE AND 4HREADED3CREWSAREUSEDFORPROXIMAL,OCKING
IN DETAIL THE 3© 4IBIAL .AIL 4X OFFERS SIGNIFICANTLY
INCREASED FUNCTIONALITY FOR THE TREATMENT OF FRACTURES
AS WELL AS SIMPLIFYING THE TRAINING REQUIREMENTS FOR ALL
PERSONNELINVOLVED
!N %ND #AP IS AVAILABLE TO REDUCE BONY OR SOFT TISSUE
INGROWTHINTOTHEPROXIMALTHREADSOFTHENAIL
!LL IMPLANTS OF THE 3© 4IBIA 4X .AILING 3YSTEM ARE
MADEOF3TAINLESS3TEEL,6- 

4HE3©4IBIAL.AILS4XARECANNULATEDNOTSLOTTEDAND
HAVEAFLUTEDPROFILEFORANOPTIMALBENDINGSTIFFNESS

3EETHEDETAILEDCHARTONTHENEXTPAGEFORDESIGN
SPECIFICATIONSANDSIZEOFFERING


*.1-"/5
'&"563&4

3©4IBIAL.AIL4X

$IAMETER  MM
3IZES  MM  IN MM
INCREMENTS

3©,OCKING3CREWS

MM
MM&ULLY4HREADED MM

,OCKING3CREWS MM
, MM

ª(ERZOG"END
ATMMFROMDRIVINGEND

MM&ULLY4HREADED
,OCKING3CREWSFORMM.AILS
$ISTAL(OLESONLY
, MM

ª$ISTAL"END
ATMMFROMTHETIP

M
M
MM

3©4X%ND#AP
MM

ONLYONESIZE

3TANDARD


* / 4 5 3 6 . & / 5
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'&"563&4 
3&'&3&/$&4

4HE MAJOR ADVANTAGE OF THE INSTRUMENT SYSTEM IS A  -% -àLLER ET AL -ANUAL OF )NTERNAL &IXATION
BREAKTHROUGH IN THE INTEGRATION OF THE INSTRUMENT 3PRINGERn6ERLAG"ERLIN
PLATFORM WHICH CAN BE USED NOT ONLY FOR THE COMPLETE
3©.AILING3YSTEMBUTWILLBETHEPLATFORMFORALLFUTURE  -,-* 'OESSENS 2 3IJBERS *3 (ARBERS *7*,
3TRYKER4RAUMANAILINGSYSTEMSREDUCINGCOMPLEXITYAND 3TAPERT !PPLICATION OF A PROXIMAL ENTRY POINT FOR
INVENTORY INTRAMEDULLARY NAILING OF THE TIBIA /STEOSINTHESE
)NTERNATIONAL  
4HE INSTRUMENT PLATFORM OFFERS ADVANCED PRECISION AND
USABILITY AND FEATURES ERGONOMICALLY STYLED TARGETING  7ILLIAM - 2ICCI -ICHAEL /@"OYLE *OSEPH "ORRELLI
DEVICES #ARLO "ELLABARBA AND 2OY 3ANDERS &RACTURES OF
THE 0ROXIMAL 4HIRD OF THE 4IBIAL 3HAFT TREATED WITH
)NADDITIONTOTHEADVANCEDPRECISIONANDUSABILITYTHE )NTRAMEDULLARY .AILS AND "LOCKING SCREWS *URNAL OF
INSTRUMENTS ARE COLOR AND NUMBER CODED TO INDICATE /RTHOPAEDIC4RAUMA6OL.OPP 
THE STEP DURING THE SURGICAL PROCEDURE IN WHICH THE
INSTRUMENTISUSED

3TEP #OLOR .UMBER

/PENING 2ED 
2EDUCTION "ROWN 
.AIL)NTRODUCTION 'REEN 
'UIDED,OCKING ,IGHT"LUE 
&REEHAND,OCKING $ARK"LUE 

$RILLS
$RILLSFEATURECOLORCODEDRINGS

MM'REEN
&ORMM&ULLY4HREADED,OCKING3CREWS

MM/RANGE
&ORMM&ULLY4HREADED,OCKING3CREWSFORTHEDISTAL
HOLESONLYFORTHEMM4IBIAL.AIL4X


* / % * $ "5 * 0 / 4


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4HE3©4IBIAL.AIL4XISINDICATEDFOR

s /PENANDORCLOSEDTIBIALSHAFTFRACTURESWITHAVERY
PROXIMAL ANDOR VERY DISTAL EXTENT IN WHICH LOCKING
SCREWFIXATIONCANBEOBTAINED
s -ULTI FRAGMENTFRACTURES
s 3EGMENTALFRACTURES
s #ORRECTIVEOSTEOTOMIES
s -AL UNIONS
s .ON UNIONS
s 0ATHOLOGICANDIMPENDINGPATHOLOGICFRACTURES
s 4UMORRESECTIONS
s0SEUDARTHROSIS


13&01&3"5*7&
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!N 8 2AY 4EMPLATE 4IBIA 4X   IS AVAILABLE FOR
PRE OPERATIVEPLANNING&IG 
4HOROUGH EVALUATION OF PRE OPERATIVE RADIOGRAPHS OF
THE AFFECTED EXTREMITY IS CRITICAL #AREFUL RADIOGRAPHIC
EXAMINATION CAN HELP PREVENT INTRA OPERATIVE
COMPLICATIONS

&OR STANDARD MID SHAFT FRACTURES THE PROPER NAIL LENGTH

SHOULD EXTEND FROM JUST BELOW THE 4IBIAL 0LATEAU AT THE
APPROPRIATE MEDIOLATERAL POSITION TO JUST PROXIMAL TO THE
%PIPHYSEAL3CAROFTHEANKLEJOINT

.OTE#HECKWITHLOCALREPRESENTATIVEREGARDING
AVAILABILITYOFNAILSIZES

&IG


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A 4HEPATIENTISPLACEDINTHESUPINEPOSITIONONARADIOLUCENT
FRACTURETABLEANDTHELEGISHYPERFLEXEDONTHETABLEWITHTHE
AIDOFALEGHOLDEROR
B 4HELEGISFREE DRAPEDANDHUNGOVERTHEEDGEOFTHETABLE
&IG 
4HE KNEE IS FLEXED TO ª ! TRIANGLE MAY BE USED UNDER
THE KNEE TO ACCOMMODATE FLEXION INTRA OPERATIVELY )T IS
IMPORTANT THAT THE KNEE REST BE PLACED UNDER THE POSTERIOR
ASPECTOFTHELOWERTHIGHINORDERTOREDUCETHEOPPORTUNITY
OFVASCULARCOMPRESSIONANDTHERISKOFPUSHINGTHEPROXIMAL
FRAGMENTOFTHETIBIAFORWARD
!NATOMICAL REDUCTION CAN BE ACHIEVED BY INTERNAL OR
&IG EXTERNAL ROTATION OF THE FRACTURE AND BY TRACTION ADDUCTION
OR ABDUCTION AND MUST BE CONFIRMED UNDER IMAGE
INTENSIFICATION $RAPING MUST LEAVE THE KNEE AND THE DISTAL
ENDOFTHELEGEXPOSED


*/$*4*0/

!PARA TENDENOUSINCISIONISMADEFROMTHEPATELLAEXTENDING
DOWNAPPROXIMATELY CMINPREPARATIONOFNAILINSERTION
4HE0ATELLAR4ENDONMAYBERETRACTEDLATERALLYORSPLITATTHE
JUNCTION OF THE MEDIAL THIRD AND LATERAL TWO THIRDS OF THE
0ATELLAR,IGAMENT4HISEXPOSESTHEENTRYPOINT&IG 

- . 
&/53:
10*/5
"ASED ON RADIOLOGICAL IMAGE THE MEDULLARY CANAL IS
OPENEDTHROUGHASUPEROLATERALPLATEAUENTRYPORTAL 4HE
CENTER POINT OF THE PORTAL IS LOCATED SLIGHTLY MEDIAL TO THE
LATERAL TIBIAL SPINE AS VISUALIZED ON THE !0 RADIOGRAPH AND
&IG &IG IMMEDIATELY ADJACENT AND ANTERIOR TO THE ANTERIOR ARTICULAR
MARGIN AS VISUALIZED ON THE TRUE LATERAL RADIOGRAPH 4O
REDUCE THE RISK OF DAMAGING THE INTRA ARTICULAR STRUCTURE
DURING PORTAL PLACEMENT AND NAIL INSERTION RADIOGRAPHIC
CONFIRMATION OF THIS AREA IS USED &IG   4HE OPENING
SHOULD BE DIRECTED WITH A CENTRAL ORIENTATION IN RELATION TO
THEMEDULLARYCANAL!FTERPENETRATINGTHECORTEXWITHTHE
X MM + 7IRE  3  THE ŒMM 2IGID 2EAMER
  IS USED TO ACCESS THE MEDULLARY CANAL &IG  
!LTERNATIVELYTHEŒMM!WL3TRAIGHT  MAYBE
USEDTOPENETRATETHECORTEX&IG 

.OTE!MOREDISTALENTRYPOINTMAYRESULTINDAMAGETOTHE
POSTERIORCORTEXDURINGNAILINSERTION
.OTE 'UIDING THE 2IGID 2EAMER OVER THE + 7IRE PRIOR TO
+ 7IREINSERTIONWITHINTHE0ROXIMAL4IBIAWILLHELPTOKEEP
IT STRAIGHT WHILE GUIDING THE OPENING INSTRUMENT CENTRALLY
TOWARDSTHECANAL$ONOTUSEBENT+ 7IRES
&IG &IG


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)F AN UNREAMED TECHNIQUE IS PREFERRED THE  X MM

3MOOTH4IP'UIDE7IRE 3 ISPASSEDTHROUGH
THE FRACTURE SITE USING THE 'UIDE 7IRE (ANDLE 
 AND   &IG   )NTERNAL ROTATION DURING
INSERTION WILL AID IN PASSING THE 'UIDE 7IRE DOWN THE
TIBIAL SHAFT 4HE 'UIDE 7IRE SHOULD LIE IN THE CENTER OF
THE METAPHYSIS AND THE DIAPHYSIS IN BOTH THE !0 AND
-, VIEWS TO AVOID OFFSET POSITIONING OF THE NAIL 4HE
'UIDE7IRE(ANDLEISREMOVEDLEAVINGTHE'UIDE7IRE


3&".&%
5&$)/*26& &IG

&ORREAMEDTECHNIQUESTHEXMM"ALL4IP'UIDE .OTE4HE"ALL4IPATTHE

7IRE 3 ISINSERTEDTHROUGHTHEFRACTURESITE ENDOFTHE'UIDE7IREWILL
%XCEPT FOR THE MM 4IBIAL .AILS USE OF THE "ALL 4IP STOPTHE"IXCUTREAMER
'UIDE7IREDOESNOTREQUIREA'UIDE7IREEXCHANGE HEAD&IG 
4HE5NIVERSAL2ODWITH2EDUCTION3POONOR2EDUCTION
4IPMAYBEUSEDASAFRACTUREREDUCTIONTOOLTOFACILITATE
'UIDE7IREINSERTIONTHROUGHTHEFRACTURESITE&IG 

2EAMING &IG  IS COMMENCED IN MM INCREMENTS

UNTILCORTICALCONTACTISAPPRECIATED&INALREAMINGSHOULD
BEMM MMLARGERTHANTHEDIAMETEROFTHENAILTO
BEUSED

.OTE 4HE PROXIMAL DIAMETER OF THE MM MM

DIAMETER NAILS IS MM !DDITIONAL PROXIMAL &IG
METAPHYSEAL REAMING MAY BE REQUIRED TO FACILITATE
NAIL INSERTION .AIL SIZES  MM HAVE A CONSTANT
DIAMETER

"IXCUT š2EAMER

4HECOMPLETERANGEOF"IXCUT©REAMERSISAVAILABLEWITH
EITHERMODULARORFIXEDHEADS
4HE OPTIMIZED CUTTING FLUTE GEOMETRY IS DESIGNED TO
REDUCEINTRAMEDULLARYPRESSUREANDTEMPERATURE
4HIS IS ACHIEVED BY THE FORWARD AND SIDE CUTTING FACE
COMBINATION OF THE REAMER BLADES 4HE LARGE CLEARANCE
RATE RESULTING FROM THE REDUCED NUMBER OF REAMER
BLADES COUPLED WITH THE REDUCED LENGTH OF THE REAMER
HEAD RELIEVES THE INTRAMEDULLARY PRESSURE AND PROVIDES
EFFICIENTREMOVALOFREAMEDMATERIAL

3EEPAGES FORADDITIONAL"IXCUTš2EAMERSYSTEMDETAILS &IG &IG


0 1 & 3 "5 * 7 &
5 & $ ) / * 2 6 &

NAILDIAMETERS -,(OLES 
/"*-
4&-&$5*0/

/BLIQUE(OLES
(OLE0OSITION $IAMETER
0ROXIMAL
4HE DIAMETER OF THE SELECTED NAIL SHOULD BE
MM MMSMALLERTHANTHATOFTHELASTREAMERUSED
-,(OLES
,ENGTH
(OLE0OSITION 4HE 4IBIA 8 2AY 2ULER 4IBIA 4X   MAY BE
$ISTAL
USEDTODETERMINENAILDIAMETERANDLENGTH4HE8 2AY
!0(OLE NAILLENGTH 2ULERMAYALSOBEUSEDASAGUIDETOHELPDETERMINEFINAL
,OCKING3CREWPOSITION&IG 
&IG

!LTERNATIVELY NAIL LENGTH MAY BE DETERMINED BY

MEASURINGTHEREMAININGLENGTHOFTHE'UIDE7IRE4HE
'UIDE 7IRE 2ULER   IS PLACED ON THE 'UIDE
7IREANDTHECORRECTNAILLENGTHISREADATTHEENDOFTHE
'UIDE7IREONTHE'UIDE7IRE2ULER&IG 

4HE'UIDE7IRE2ULERISCALIBRATEDFORMM
'UIDE7IRESWITHMARKINGSFORTHE4IBIAAND&EMUR

5PONCOMPLETIONOFREAMINGTHEAPPROPRIATESIZENAILIS
%NDOF'UIDE READYFORINSERTION
7IRE2ULER

&IG

&IG

%NDOF'UIDE7IRE2ULER
EQUALS-EASUREMENT2EFERENCE


0 1 & 3 "5 * 7 &
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3TRIKE0LATE

4HESELECTEDNAILISASSEMBLEDONTOTHE4IBIAL4ARGET
$EVICE  WITHTHE4IBIAL.AIL(OLDING3CREW
  &IG 3ECURELYTIGHTENTHE.AIL(OLDING .AIL(OLDING3CREW
3CREWWITHTHE)NSERTION7RENCH  SOTHATIT
DOESNOTLOOSENDURINGNAILINSERTION

4O ATTACH THE .AIL (ANDLE TO THE 4ARGETING !RM TURN
THE 1UICK ,OCK 2ING OF THE 4ARGETING !RM CLOCKWISE .AIL(ANDLE
4RIANGLESONTHE1UICK ,OCK2INGANDTHE4ARGETING!RM
INDICATE THE CORRECT POSITION TO ATTACH THE .AIL (ANDLE
WHENBOTHTRIANGLESAREINLINEWITHEACHOTHER

.OTE0RIORTOINSERTION
 2ECHECK THAT THE .AIL IS TIGHTLY SECURED TO THE .AIL
(ANDLE
 6ERIFY THE CORRECT POSITION OF THE NAIL RELATIVE TO THE
4ARGETING!RM
.AIL(ANDLEASINDICATEDONTHEINSERTIONPOST
!DRILLBITMAYBEINSERTEDTHROUGHTHETARGETINGDEVICE
ANDTHROUGHTHENAILHOLESTOHELPCHECKALIGNMENTAND
HOLECONFIGURATION
 4HE MM 4IBIAL .AILS REQUIRE EXCHANGING THE  X
MM"ALL4IP'UIDE7IRE 3 FORTHEX
MM3MOOTH 4IP'UIDE7IRE 3 PRIORTO 1UICK,OCK
INSERTION
5SETHE4EFLON4UBE 3 TOFACILITATETHE'UIDE
&IG
7IREEXCHANGE

4HE 3TRIKE 0LATE   IS THREADED INTO THE .AIL
(ANDLE NEXT TO THE .AIL (OLDING 3CREW OR DIRECTLY INTO
THE .AIL (OLDING 3CREW TO AVOID ANY UNINTENTIONAL
BENDINGMOMENTDURINGNAILINSERTION

4HE .AIL IS INSERTED BY HAND OVER THE  X MM "ALL
4IP 'UIDE 7IRE IF USED AND INTO THE ENTRY SITE OF THE
PROXIMAL TIBIA &IG   'ENTLY MANIPULATE THE NAIL TO
HELPAVOIDPENETRATIONOFTHEPOSTERIORCORTEX)FTHENAIL
IS DEFLECTED TOWARDS THE POSTERIOR CORTEX REMOVE THE
NAILANDHYPERFLEXTHEKNEE5NDERIMAGECONTROLUSEA
STRAIGHTREAMERTOREAMANANTERIORTRACTINTHEPROXIMAL
FRAGMENT

4HE .AIL IS ADVANCED THROUGH THE ENTRY POINT PAST THE
FRACTURESITETOTHEAPPROPRIATELEVEL2EMOVETHE'UIDE
7IREONCETHENAILISPASTTHEFRACTURESITE

&IG


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$0/5*/6&%

4HE 3LOTTED (AMMER   CAN BE USED ON THE
3TRIKE 0LATE &IG  OR IF DENSE BONE IS ENCOUNTERED
!LTERNATIVELY THE 5NIVERSAL 2OD   MAY BE
ATTACHED TO THE 3TRIKE 0LATE AND USED IN CONJUNCTION
WITH THE 3LOTTED (AMMER TO INSERT THE NAIL &IG   !
CAPTURED3LIDING(AMMER  ISAVAILABLEASAN
vOPTIONALhADDITIONTOTHESTANDARDINSTRUMENTSET

4HE THREE CIRCUMFERENTIAL GROOVES ON THE INSERTION POST

ACTASAGUIDEWHILEINSERTINGTHENAILTOTHECORRECTDEPTH
&IG   4HE CORRECT DEPTH POSITION FOR THE 3© 4IBIAL
.AIL4XMAYBEDETERMINEDWITHTHEFIRSTPROXIMALGROOVE
OFTHE.AIL!DAPTER
&IG

NN

NN

&IG
NN

7HENLOCKINGTHE4IBIAL.AIL4XTHENAILISCOUNTERSUNK

A MINIMUM OF MM TO THE CHONDRAL SURFACE 4HE FINAL
NAILDEPTHSHOULDBEWELLBELOWTHECHONDRALSURFACETO
MINIMIZEIRRITATIONOFTHE0ATELLAR4ENDON

2EPOSITIONINGOFTHENAILSHOULDBECARRIEDOUTEITHERBY
HANDORBYUSINGTHE3TRIKE0LATEATTACHEDTOTHE4ARGET
$EVICE 4HE 5NIVERSAL 2OD   AND 3LOTTED
&IG
(AMMER MAY THEN BE ATTACHED TO THE 3TRIKE 0LATE TO
CAREFULLYANDSMOOTHLYRETRACTTHEASSEMBLY
$/./4HITONTHE4ARGET$EVICE

4ECHNICAL 4IP ! CHAMFER IS LOCATED ON THE PROXIMAL

END OF THE NAIL TO HELP IDENTIFY THE JUNCTION OF THE
NAIL AND INSERTION POST UNDER FLUOROSCOPY 4HE THREE
CIRCUMFERENTIALGROOVESONTHEINSERTIONPOSTARELOCATED
ATMMMMANDMMFROMTHEPROXIMALENDOFTHE
NAILANDHELPDETERMINEDEPTHOFINSERTION

!TTACH THE 4ARGETING !RM BY ROTATING THE SPRING LOADED

1UICK ,OCK 2ING ON THE 4ARGET !RM CLOCKWISE WHILE
CONNECTINGITTOTHEKNOBONTHEENDOFTHE.AIL(ANDLE
&IG 

.OTE 2EMOVE THE 'UIDE 7IRE PRIOR TO DRILLING HOLES

ANDINSERTTHE,OCKING3CREWS
&IG


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7*"
5"3(&5
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"EFORE LOCKING THE NAIL PROXIMALLY CONFIRM THAT THE

.AIL (OLDING 3CREW IS SECURELY TIGHTENED BY USING THE
.AIL(ANDLE
5NIVERSAL *OINT 3OCKET 7RENCH AND CHECK THAT THE
4ARGETING!RMISPROPERLYATTACHEDTOTHE.AIL(ANDLE

4HE4ARGET$EVICEWASDESIGNEDTOWORKWITHTHE4©
4IBIAL .AILS 4HEREFORE IT FEATURES MORE LOCKING OPTIONS
THANNEEDEDFORTHE3©4IBIAL.AIL4X&IG 
4ARGETING!RM
.OTE$/./453%4(%$9.!-)#
(/,% OF THE 4ARGET $EVICE 4HERE
ISNOCORRESPONDINGHOLEINTHE3
4IBIAL.AIL4X

&IG

&OR44IBIAL.AILSONLY

)MPORTANT &OR THE 'UIDED ,OCKING OF THE 3© 4IBIAL 

.AIL4XUSETHE3TATICHOLES/.,9&IG

4HE4ISSUE0ROTECTION3LEEVE,ONG  TOGETHER

WITH THE $RILL 3LEEVE ,ONG   AND THE 3HORT
4ROCAR ,ONG   IS INSERTED INTO THE 4ARGET
$EVICEBYPRESSINGTHE3AFETY#LIP&IG 4HE&RICTION
,OCKING MECHANISM WILL KEEP THE SLEEVE IN PLACE AND  
PREVENTITFROMFALLINGOUT)TWILLALSOPREVENTTHESLEEVE
FROMSLIDINGDURINGSCREWMEASUREMENT &IG

4O RELEASE THE 4ISSUE 0ROTECTION 3LEEVE THE 3AFETY #LIP

MUST BE PRESSED AGAIN AND HELD WHILE REMOVING THE
SLEEVE&IG 

3AFETY#LIP

RELEASED LOCKED
&IG


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&OR LOCKING OF THE 3© 4IBIAL .AIL 4X BOTH PROXIMAL

/BLIQUE ,OCKING 3CREWS AND THE -, ,OCKING 3CREW MAY
BE USED )N HIGLY UNSTABLE COMMINUTED FRACTURES THIS
LOCKING CONFIGURATION IMPROVES STABILITY OF THE PROXIMAL
FRAGMENT

!LWAYS START WITH THE MOST DISTAL OBLIQUE &ULLY 4HREADED

,OCKING 3CREW 4HE 4ISSUE 0ROTECTION 3LEEVE ,ONG
ASSEMBLED WITH THE $RILL 3LEEVE ,ONG AND THE 4ROCAR
,ONG IS POSITIONED THROUGH THE HOLE ON THE 4ARGET $EVICE
! SMALL SKIN INCISION IS MADE AND WHILE PRESSING THE
3AFETY #LIP THE 4ISSUE 0ROTECTION 3LEEVE IS PUSHED THROUGH
UNTILITISINCONTACTWITHTHEANTERIORCORTEX&IG 

&IG 4HE 4ROCAR IS REMOVED WITH THE 4ISSUE 0ROTECTION 3LEEVE
AND$RILL3LEEVEREMAININGINPOSITION

&OR ACCURATE DRILLING AND EASY DETERMINATION OF SCREW

LENGTH USE THE CENTER TIPPED CALIBRATED ŒX $RILL
 3  4HE CENTERED $RILL IS FORWARDED THROUGH
THE$RILL3LEEVEANDPUSHEDONTOTHECORTEX

!FTER DRILLING BOTH CORTICES THE SCREW LENGTH MAY BE

READ DIRECTLY OFF OF THE CALIBRATED $RILL AT THE END OF
THE $RILL 3LEEVE )F MEASUREMENT WITH THE 3CREW ,ONG
  IS PREFERRED FIRST REMOVE THE $RILL 3LEEVE
,ONG AND READ THE SCREW LENGTH DIRECTLY AT THE END OF THE
4ISSUE0ROTECTION3LEEVE,ONG&IG 

.OTE 4HE POSITION OF THE END OF THE $RILL AS
IT RELATES TO THE FAR CORTEX IS EQUAL TO WHERE
THE END OF THE SCREW WILL BE 4HEREFORE IF
THE END OF THE $RILL IS MM BEYOND THE FAR
CORTEX THE END OF THE SCREW WILL ALSO BE
MMBEYOND
&IG

)MPORTANT 4HE 3CREW IS CALIBRATED SO THAT WITH

THE BEND AT THE END PULLED BACK FLUSH WITH THE FAR
CORTEX THE SCREW TIP WILL END MM BEYOND THE FAR
CORTEX&IG 
MM

!LTERNATIVELY STOP THE DRILL WHEN IT ENGAGES THE FAR CORTEX
AND MEASURE THE DRILL BIT DEPTH OFF OF THE CALIBRATED
DRILL !DD MM TO THIS LENGTH
TO OBTAIN THE CORRECT SCREW
LENGTH

&IG


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7HEN THE $RILL 3LEEVE IS REMOVED THE CORRECT ,OCKING

3CREW IS INSERTED THROUGH THE 4ISSUE 0ROTECTION 3LEEVE
USINGTHE3CREWDRIVER3HAFT,ONG  &IG 

&IG

4HESCREWISADVANCEDTHROUGHBOTHCORTICES4HESCREW
IS NEAR ITS PROPER SEATING POSITION WHEN THE GROOVE
AROUNDTHESHAFTOFTHESCREWDRIVERAPPROACHESTHEEND
OFTHE4ISSUE0ROTECTION3LEEVE&IG 

&IG

2EPEAT THE LOCKING PROCEDURE FOR THE MORE PROXIMAL

OBLIQUEANDTHE-,,OCKING3CREWS&IG 

&IG


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'3&&)"/%
-0$,*/(

4HEFREEHANDTECHNIQUEISUSEDTOINSERT,OCKING3CREWS
INTOBOTHTHE-,AND!0HOLESINTHENAIL2OTATIONAL
ALIGNMENT MUST BE CHECKED PRIOR TO LOCKING THE NAIL
STATICALLY

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