Sign IM Nail and Interlocking Screw System Technique Manual page 27

Reaming
Introduce the reamers after the bone entrance has been made using the awl. The reamers are rotated
360º in a clockwise manner. This is important to preserve the cutting edges which go only one way.
Look at the distal femur fragment if the fracture site is exposed to direct the reamer. Save the bone
from the flutes of the reamer in a bone cup for use as a bone graft. Do not place in sponge or saline.
Diameter of the nail is determined by noting the size of the reamer that creates chatter in the isthmus
of the femoral canal. Use a nail whose diameter is 2mm smaller than the reamer that created the
chatter.
Nail insertion
The bend of the nail is angled apex
anteriorly. The nail should not end at or
less than 6cm below the lesser trochanter,
figure 3. The nail may end short of this
high stress area or extend past it. We are
studying benefits of each length.
Fig. 3
Fig. 4
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High
stress
area
Stop advancing the nail when the ring
touches the articular cartilage on the medial
femoral condyle, figure 4. Check the
tightness of the locking bolt to the nail. The
nail should be inserted so the ring rests on
the articular surface of the medial femoral
condyle. The nail will then be just below the
articular surface, figure 4.