Indication For Sign Nails - Sign IM Nail and Interlocking Screw System Technique Manual

FRACTURE TYPE
a. Closed at time of injury
Fractures that cannot be reduced or lose reduction.
b. Open-acute
Fractures that are Gustilo grade I, II, III a, debrided and closed within 24 hours of injury may
have immediate SIGN nail insertion. Sometimes this time limit is impossible, so we must
study the elapsed time between injury and surgery if antibiotics are given within 6 hours from
injury. If closure is delayed, the surgeon should determine when the SIGN nail is placed at
wound closure.
c. Open-delayed closure
Debrided and covered by skin, muscle or free flap, with no drainage, may have SIGN
nail insertion.
d. Fractures treated by external fixation
Risk of infection is increased if external fixation pins are present for over 10 days but we are
studying this as closure at 10 days may not be indicated.
e. Non-unions
PATIENT PREPARATION
Patient must have no infected areas or injuries that preclude surgery. Patient should be told about
risks, benefits of surgery and agree to insertion of SIGN nail. Please check the patient's skin the night
before surgery. If possible, washing the patient's leg should be done the night before. The cast may
be removed for washing.
Check list for the night before surgery
1. Any infections? Where? – Surgery should be postponed.
2. Skin of extremity washed well.
3. Range of motion of knee? – need 60
4. Template X-rays to estimate size of nail, screws.
5. X-rays to be in OR.
6. Check appropriate lab work.
SURGEON PREPARATION
Read the technique manual and /or watch the technique CD. Be contemplative surgeons.
X-RAYS
X-rays should include knee and ankle on the same film to measure the nail. X-rays should be present
in OR during surgery. Look carefully for fracture comminution.
ANTIBIOTICS
Antibiotics are started 1 hour before surgery.
INDICATIONS FOR SIGN NAIL
flexion to do retrograde femur approach.
°
6