Sign IM Nail and Interlocking Screw System Technique Manual page 35

Instruments
The standard or short target arm is used for the proximal interlocking, figure 4.
Fig. 4
Technique
Open or closed reduction can be used.
The technique used in standard SIGN nail is the same except for the reaming.
Triple Ream
First ream
Ream until chatter is felt for 4-6cm of the canal. The size of the fin is 1mm larger than this reamer.
Second ream
Ream with the next larger size reamer but stop at the mark pertaining to the length of the fin nail
selected, figure 5.
Fig. 5
240mm
Third ream
Ream using the next 2 larger sizes to accommodate for the bend of the nail. This reamer only
penetrates 4cm.
Proximal interlocking
This procedure is similar to proximal interlocking of the standard SIGN nail. The proximal portion of
the standard target arm, short target arm, or hip and pediatric target arm may be used.
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