Tibial intramedullary nailing (suprapatella approach): Synthes Expert Tibial Nail surgical technique
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There are various ways to manage tibial fractures in general and compound tibial fractures in particular. Where the local expertise exists the council of perfection involves collaborative management by Orthopaedic surgeons and their Plastic surgical colleagues. Open fractures should be managed according to the British Orthopaedic Association (BOA) & British Association of Plastic, Reconstructive & Aesthetic Surgeons (BAPRAS) Audit Standards for Trauma [BOAST – Open Fractures; December 2017].
We present the case of an isolated open tibial diaphyseal fracture that has been stabilised with an Expert Tibial Nail. In a combined Ortho-Plastic approach, the wound is debrided and washed out prior to making a partial medial fasciotomy incision. Through this separate incision, the bone ends are delivered, debrided, washed out and the wounds then closed primarily. The fracture is held and reduced with the Staffordshire Orthopaedic Reduction Machine (STORM – designed and distributed by Metaphysis) and then a suprapatella tibial nailing is performed.
A recent meta-analysis [Wang et al 2018] suggested that potential advantages of the suprapatella approach for tibial nailing might include shorter fluoroscopy time, reduced knee pain and improved knee recovery as well as more accurate fracture reduction compared to the more common approaches.
The Expert Tibial Nail from Depuy Synthes is a titanium alloy nail which has advanced proximal and distal locking options that assist in the control and stabilisation of difficult fracture patterns. This allows either very proximal or very distal fractures to be controlled. Distally there is also a screw angle specifically for Tillaux type fracture fragments. Proximally there are also cancellous locking bolts that give enhanced bone purchase in this region. The insertion of an end cap locks the most proximal locking bolt and converts the nail / proximal locking bolt into a fixed angle construct. Depuy expert nails are available as both solid and cannulated nails. Importantly the ball tipped guide wire will pass through the nail, so that it doesn’t have to be exchanged after reaming and prior to nail insertion. For suprapatella nailing the same nails are used which means no additional implants are required (though there is a different insertion handle and instrumentation tray).
Author: Mr Ross Fawdington FRCS Ed (Tr & Orth).
Institution: Queen Elizabeth Hospital, Birmingham, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
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- The timer suspends after 5 minutes though if there is no activity.
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The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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