Sign IM Nail and Interlocking Screw System Technique Manual page 13

Open fractures
Adequate debridement is essential. The amount of tissue removed is dependent on vascular supply,
muscle damage, and bacterial contamination. Bone fragments that are completely devascularized
must be removed. Dead space must be closed. We must study proper timing of wound closure. If the
wound is cleaned and can be closed, the nail can be inserted. If not, external fixation is necessary. If
bone loss has occurred, consider methyl methacrylate insertion into the bone defect. At 6 weeks
remove the methyl methacrylate but do not disturb the membrane that formed. Place bone graft for
small defects. The membrane formed around the methyl methacrylate is bioactive and will accelerate
bone formation. Bone transport is used for large defects. If there is a large skin defect, consider
closing the wound with flaps. The nail should not be placed until the flaps are covered.
Reaming from bone entrance
Skin incision and location of bony entrance will be described in sections for specific fractures. Use
the reamers to extend the bone entrance hole into the diaphysis. Use the tissue protector to keep the
reamers from touching the skin. Ream until chatter and then select nail diameter 2mm smaller. Over
ream by 4mm for 4cm distal to the entrance hole. This will accommodate the bend in the nail. Apply
counter pressure as reaming becomes more forceful. Save the bone from the flutes of the reamer and
the fluid that comes out of the bone entrance when the reamer is withdrawn in a bone cup. It is best
not to place this bone on a sponge or mix with saline.
If you are unsure that the reamer or nail is in the
canal of the distal fragment, push the reamer or Fig. 5
nail until resistance is encountered. If there is
no resistance, the reamer or nail is not in the
canal. The length of the nail is determined by
placing a blunt reamer down to subchondral
bone and measuring this length in the tibia,
figure 5. The femur length of the nail is
measured by estimation using another reamer.
The reamers are marked at 320mm to help
determine the length of the nail.
Blocking screws can be used to aid in inserting
the nail in proximal and distal fractures of femur and tibia.
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