Interlocking Nails Uses, Sizes and Surgical Techniques.

PFN Nail (Proximal Femoral Nail)

TENS Nail (Titanium Elastic Nail)

What is Interlocking Nails?

Interlocking Nails combines the advantages of closed medullary nailing with added fixation of inserted transfixion screws, introduced through predrilled holes at proximal or distal end of nail or both. When both the proximal and distal end of nail are locked, it is termed, “static” and when only proximal or distal end of nail is locked, it is termed, “dynamic”. The static fixation may be converted to dynamic during later stages of healing. Interlocking nails provide a stable nail-bone construct during the healing process.

The advantages of interlocking Nails are that they can be used for fractures which are unsuitable for standard medullary fixation, those with severe comminution, bone loss and those beyond the isthmic zone if transfixing interlocking screws are used. Whittle and co-workers have reported the development and use of closed section interlocking intramedullary nails designed with smaller diameters and modified section modules to allow insertion with non reamed techniques in open fractures with low infection rates.

Interlocking Nails system requires sophisticated equipment for insertion and extraction of nails. Certain systems require a separate inventory of nails for right and left sides. Image intensifier is necessary. Procedure is difficult and the learning curve is long. Interlocking pins/bolts at times break/bend and wings may get stuck inside medullary cavity leading to difficulty in extraction of nails. There may be fatigue failure of nails.

Interlocking Nails are the preferred mode of treatment for fractures of long bones viz. femur, tibia and humerus. Presently, more than 95 per cent of femoral fractures and unstable tibial fractures can be treated with interlocking nails.

Interlocking Nails

Interlocking Nails Uses.

Interlocking Nail is a nail placed within the medullary cavity of a long bone secured in position by proximal and distal transfixing screws to provide axial, bending and torsional stability. They are best suited for diaphyseal fractures and particularly useful in cases with extensive comminution. They permit early return to limb function with the added advantage of minimal soft tissue morbidity. Common places for application are the femur, humerus, and tibia. Due to the curvature of the canine femur, shorter nails than would ideally be used are often required. In some cases, the femur is repaired in a slightly straighter alignment than it was prior to fracture. This is referred to as overreducing a fracture.

Interlocking Nailing of complex fractures of the femur and tibia.

Interlocking Nails widens the range of indications for medullary osteosynthesis of femoral and tibial shaft fractures. Stability is achieved by transverse threaded bolts in prefabricated holes in the nail, which anchor the implant directly to cortical bone, thereby controlling length, alignment, and rotation of the limb. Two hundred eighty-three femoral and 401 tibial fractures were treated with an Interlocking Nail and followed for an average of 20 months. Overall, 97% of the femurs and 94.3% of the tibias were judged to have an excellent or good result, based on both clinical and radiographic parameters. Delayed union or nonunion requiring bone grafts occurred in 2% of the femurs and 0.7% of the tibias following Interlocking Nailing. Deep infection developed in 2.4% of the femurs and 2.2% of the tibias. All of these patients eventually healed their fractures without evidence of chronic osteomyelitis. The main advantage of Interlocking Nails are that surgery can be performed using closed nailing techniques, allowing early protected weight-bearing and joint motion. The rates of nonunion and infection are very low, and there is little risk of refracture after implant removal.

Interlocking Nails Instruments

Interlocking Nails come in different lengths, thicknesses, and vary in their number of screw holes. There are many instruments used in Interlocking Nails systems, some of them are given below.

Tibia Nail Instruments Set

Distal Jig
Proximal Jig
Cannulated Guide Rod with Ram
T Handle with Jacob Chuck
Distal Aiming Device
T Handle for Flexible Shaft
Depth Gauge
Flexible Reaming Shaft

Shaft for Reamers
Direction Finder
Guide Rod
Bone Awl
Holding Forcep
Nail Holding Bolt
Medullary Tube
Tissue Protector

Screw Driver
Protection Sleeve
Drill Sleeve
Trocar
Aiming Trocar
Spanner
Medullary Reamers
Drill Bit
Guide Rod

Interlocking Nails Types

PFNA Nail
PFNA2 Nail
PFN Nail (Proximal Femoral Nail)
Expert Tibia Nail
Tibia Nail
Femoral Nail
Humeral Nail
TENS Nail (Titanium Elastic Nail)

Interlocking Nails Instruments Set

PFNA Nail Instruments Set
PFNA2 Nail Instruments Set
PFN Nail (Proximal Femoral Nail) Instruments Set
Expert Tibia Nail Instruments Set
Tibia Nail Instruments Set
Femoral Nail Instruments Set
Humeral Nail Instruments Set
TENS Nail (Titanium Elastic Nail) Instruments Set

Interlocking Nails Screws

3.4 mm Locking Bolt
3.9 mm Locking Bolt
4.9 mm Locking Bolt
6.4 mm Proximal Cannulated Bolt
8 mm Proximal Cannulated Bolt
PFNA2 Blade
PFNA Blade

Interlocking Nails Contraindications

Contraindications may be qualified or total, and need to be taken into consideration when evaluating the prognosis in each case. The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include:

Any active or suspected latent infection or marked local inflammation in or about the affected area.
Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site.
Bone stock compromised by disease, infection or prior implantation that can not provide adequate support and/or fixation of the devices.
Material sensitivity, documented or suspected.
Obesity. An overweight or obese patient can produce loads on the implant that can lead to failure of the fixation of the device or to
failure of the device itself.
Patients having inadequate tissue coverage over the operative site.
Interlocking Nails utilization that would interfere with anatomical structures or physiological performance.
Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications in postoperative care.
Other medical or surgical conditions which would preclude the potential benefit of surgery.
All associated diseases which could endanger the function and success of the implant.

Warnings and Precautionary for Interlocking Nails

Before using Interlocking Nails, the surgeon and ancillary staff should study the safety information in these instructions, as well as any product-specific information in the product description, surgical procedures and/or brochures.

Nails are made from medical grade materials and are designed, constructed and produced with utmost care. These quality Nails assure best working results provided they are used in the proper manner. Therefore, the following instructions for use and safety recommendations must be observed.

Improper use of Nail can lead to damage to the tissue, premature wear, destruction of the instruments and injury to the operator, patients or other persons.

It is vital for the operating surgeon to take an active role in the medical management of their patients. The surgeon should thoroughly understand all aspects of the surgical procedure and instruments including their limitations. Care in appropriate selection and proper use of surgical instruments is the responsibility of the surgeon and the surgical team. Adequate surgical training should be completed before use of implants.

Factors which could impair the success of the operation:

Allergies to implanted materials.
Localized bone tumours.
Osteoporosis or osteomalacia.
System disease and metabolic disturbances.
Alcohol and drug abuse.
Physical activities involving excessive shocks, whereby the implant is exposed to blows and/or excessive loading.
Patients who are mentally unable to understand and comply with the doctor’s instructions.
Poor general health.

Possible Adverse Effects

The following adverse effects are the most common resulting from implantation:

Loosening of the Nail, which may result from cyclic loading of the fixation site and/or tissue reaction of the implant.
Early and late infection.
Further bone fracture resulting from unusual stress or weakened bone substance.
Temporary or chronic neural damage resulting from pressure or hematomata.
Wound hematomas and delayed wound healing.
Vascular disease including venal thrombosis, pulmonary embolism and cardiac arrest.
Heterotopic ossification.
Pain and discomfort due to presence of the Interlocking Nails.
Mechanical failure of the implant, including bending, loosening or breakage.
Migration of implant resulting in injury.

Preoperative Planning for Interlocking Nails

The operating planning is carried out following a thorough clinical evaluation of the patient, Also, x-rays must be taken to allow a clear indication of the bony anatomy and associated deformities. At the time of the operation, the corresponding implantation instruments in addition to a complete size of Interlocking Nails must be available.

The clinician should discuss with the patient the possible risks and complications associated with the use of implants. It is important to determine pre-operatively whether the patient is allergic to any of the implant materials. Also, the patient needs to be informed that the performance of the device cannot be guaranteed as complications can affect the life expectancy of the device.

Interlocking Nails Precautions

Confirm functionality of instruments and check for wear during reprocessing. Replace worn or damaged instruments prior to use.
It is recommended to use the instruments identified for this Nail.
Handle devices with care and dispose worn bone cutting instruments in a sharps container.
Always irrigate and apply suction for removal of debris potentially generated during implantation or removal.

Interlocking Nails Warnings

Interlocking Nails can break during use (when subjected to excessive forces). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the individual patient, the broken part should be removed. Be aware that implants are not as strong as native bone. Implants subjected to substantial loads may fail.
Instruments, screws and cut plates may have sharp edges or moving joints that may pinch or tear user’s glove or skin.
Take care to remove all fragments that are not fixated during the surgery.
While the surgeon must make the final decision on implant removal, we recommend that whenever possible and practical for the individual patient, fixation devices should be removed once their service as an aid to healing is accomplished. Nails removal should be followed by adequate post-operative management to avoid refracture.

Interlocking Nails General Adverse Events

As with all major surgical procedures, risks, side effects and adverse events can occur. While many possible reactions may occur, some of the most common include: Problems resulting from anesthesia and patient positioning (e.g. nausea, vomiting, dental injuries, neurological impairments, etc.), thrombosis, embolism, infection, nerve and/or tooth root damage or injury of other critical structures including blood vessels, excessive bleeding, damage to soft tissues incl. swelling, abnormal scar formation, functional impairment of the musculoskeletal system, pain, discomfort or abnormal sensation due to the presence of the device, allergy or hypersensitivity reactions, side effects associated with hardware prominence, loosening, bending, or breakage of the device, mal-union, non-union or delayed union which may lead to breakage of the Interlocking Nails, reoperation.

Interlocking Nails Uses, Sizes and Surgical Techniques.

Gamma Nail

PFNA Nail

PFNA2 Nail

PFN Nail (Proximal Femoral Nail)

Antegrade Femoral Nail (AFN)

Expert Tibia Nail

Tibial (Tibia) Nail

Femur (Femoral) Nail

Femoral Reconstruction Nail

Femoral Recon Nail

Humeral (Humerus) Nail