Sign IM Nail and Interlocking Screw System Technique Manual page 24

Skin incision
Flex the knee to feel the patella tendon. Make the skin incision in the midportion of the tendon from
the patella to the tibial tubercle. Figures 31 and 32.
Fig. 31
Bone entrance
Do not enter the fat pad. A curved awl is used to make the bone entrance. The more proximal the
fracture, the more proximal the entrance hole should be. Direct the awl anteriorly and shape the
entrance hole anteriorly especially in proximal fractures.
Reaming and placement of the nail
Fig. 33
approximated to allow passage of the reamer
and nail. The proximal bend of the nail should
be placed apex posteriorly.
Proximal tibia fractures
Use figure 4 position for proximal fractures, figure 33. Push the proximal
fragment into flexion as the curved awl makes the bone entrance and during
reaming and insertion of the nail. Resistance to reaming and nail insertion is
provided by applying countertraction during reduction of the fracture. The
blocking screw may be used if this is unsuccessful. The blocking screw can
be any cortical or
cancellous screw or
even a K wire, figure
34. We use fewer
blocking screws
because flexion of the
proximal fragment
reduces the fracture.
As the fracture site is
approached, the distal
fragment should be
24
Fig. 32
Fig. 34
Tissue protector
keeps nail off
skin.