Sign IM Nail and Interlocking Screw System Technique Manual page 16

Nail Insertion
Use the tissue protector to prevent the
nail from touching the skin. Push the
nail into the canal as far as possible.
Many surgeons do not use a mallet to
insert the nail. If you decide to use a
mallet, use small taps and rotate the
nail 10º as it proceeds down the canal,
figure 11. Apply counter pressure to
allow advance. If the nail does not
advance with the small taps, consider
using a smaller diameter nail or
reaming more. Hitting the nail
forcibly will bend the nail and make
interlock more difficult.
Leave the proximal 3mm of the nail above the cortical bone to
provide additional stability. Remember the ring on the stem tube is
3mm above the nail, figure 12.
Distal Interlock
If you follow this technique, distal interlock without C-arm is
successful quickly in approximately 80% of your surgeries. Further
techniques to obtain distal interlock are listed after this technique.
Please send us your ideas.
The distal interlock is done before the proximal interlock so the nail
can be rotated to find the slot in the nail.
Fig. 13
Fig. 11
Reattach the target arm to the L-handle, figure 13.
Be sure the locking bolt is tight.
Decide whether you will use 1 or 2 interlocking
screws. If one interlocking screw is sufficient, place
the screw in the hole nearest the fracture. Use the
alignment pin to mark the location for the skin
incision. Be sure the skin incision is large enough
to place the cannula and your finger on the bone.
This finger is used to identify the location of the
cannula on the bone. If the cannula is directed by
the target arm so it does not hit the bone, loosen the
distal cap screws and adjust the target arm so the
cannula will direct the hole into the cortex. You
will find slot in nail for interlock by rotation of the
nail. Champher the hole with the screw hole broach
toward the bone.
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Fig. 12