Removal Of Broken Nail - Sign IM Nail and Interlocking Screw System Technique Manual

1. It is important to leave the proximal end of the nail and the screws prominent. Many times I
see that the nail has been placed inside the bone and I am concerned about removal later on. It
is much easier to find the interlocking screws if they are left prominent.
2. Try to use the same distal holes for interlocking in the replacement nail if the broken nail is
SIGN. Use the same length of nail, but a wider width. Four holes in the femur provide a stress
concentrator which may result in a fracture at the distal interlocking area. If the broken nail is
not SIGN try to line up at least one hole to SIGN slot.
3. Leave one screw present until the nail can be adequately secured and pulled out. Sometimes
after the distal interlocking screws have been removed a screw driver or other instrument can
be left in the slots of the nail so it does not slide down. We were also able to push the nail up
using this method.
4. The advantage of using stainless steel nails over titanium becomes manifest because the bone
does not grow into stainless steel as it does into
5. Reaming results in bone graft. Don't irrigate the hematoma because this contains a great deal
of BMP.
Save bone from reaming or take bone from the entrance hole for bone grafting.
Sometimes casting or splinting after SIGN nail insertion is necessary for unstable fractures.
Weight bearing is encouraged in stable fractures. Crutches are used depending on patient's
pain.
Fracture healing is a race between bone healing and implant failure. Therefore, if healing is
delayed past 3 months, consider bone grafting.
Implant removal should be delayed for 24 months. If the nail is removed, protect the bone by
crutch for 6 to 8 weeks after removal.
If you have a comment, problem or something to share with SIGN surgeons around the world,
please e-mail or place it in the comment section of the database.
Reaming the middle fragment of a segmental fracture. There is a great decrease in
vasculularity after power reaming. I don't know if hand reaming also causes a decrease.
Inserting a smaller diameter nail without reaming is an option.
Keep your sharp instruments sharp
Our drill bits have been tested and will drill a hole 300 times without becoming dull. If the drill bit
hits another metal object and a nick is formed, the drill bit will become rapidly dull. No food or drink
should be allowed in the cleaning and sterilizing process area.
Step drills will become dull if they engage the slot in the nail.
Reamers will become dull if they are not rotated clockwise. The cutting edge only goes one way.
The threads on the locking bolts and cap screws will become dull if they're forced into the hole.
Always thread using gravity.

Removal of Broken Nail

titanium.
ADDITIONAL NOTES
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