Sign IM Nail and Interlocking Screw System Technique Manual page 25

Mid and distal tibia fractures
Use gravity for other fractures. The awl is used to make the entrance
hole. Use the reamers to extend the hole into the diaphysis, figure 35.
Fig. 35
Ream until chatter and then select diameter 2mm smaller. If you are
unsure that the nail is in the canal of the distal fragment, push the
reamer until resistance is encountered. If there is no resistance, the 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,
figure 36. The reamers are marked at 320mm to help determine the
length of the nail.
NOTE: See technique used in all approaches, page 11.
Proximal Interlock
Fig. 37 Fig. 36
Drilling
The target arm should now be firmly attached to the L-Handle. Insert the alignment pin tip to the skin
to mark the location of the skin incision. Make skin incision and clear soft tissue off the bone. Place
the cannula next to bone. Use the cannula, small drill guide and small drill bit to drill a hole through
the near cortex and far cortex, figure 37.
NOTE: The slot finder is not necessary to find
Fig. 38
the nail slot for proximal interlock.
Screw insertion
Use the large drill guide and step drill to enlarge
the hole in the near cortex. Determine screw
length with help of the depth gauge. Insert the first
proximal interlocking screw. Retract the cannula
to view the head of the screw so it is not inserted
too deeply.
Remember someday the screw may need to be
removed. Insert the second proximal screw in the
same fashion. Remember the proximal aperture is
a hole and the distal is a slot.
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