1. Orthopaedic Trauma Association Protection and/or confidentiality of contents statement, this statement may also include a corporate copyright notice. Intro to IM Nailing Lab Comprehensive Fracture Course

2. Tibia IM Nail Now we will put into practice what we have learned 2 Models available – “Standard” midshaft fx – Proximal 1/3 fracture Requires additional reduction techniques

3. Tibial IM Nail Trigen Nail by Smith and Nephew 32 cm nail

4. Tibia IM Nail Most important part of IMN is obtaining proper start point – (2 nd most important is obtaining and maintaining reduction) Take the time to find correct start point

5. Tibia IM Nail For tibia – Just medial to lateral tibial spine on AP – In center of anterior tibial slope

6. Tibia IM Nail Steps – Obtain start point with threaded guide pin – Place pin ~5 cm deep – Ream with cannulated reamer This model is already reamed down the shaft – Place nail but DO NOT interlock at proximal end yet

7. Tibia IM Nail Distal Locking – SureShot targeting device Place long wire down nail to 32 cm line Utilize targeting screen to line up circles concentrically Drill through central hole with 4.0 mm drill while holding hand still Place interlocking screw 3 distal holes available

8. Tibia IM Nail Once distal targeting screws placed… REMOVE SURE SHOT WIRE Then place proximal interlocks

9. Tibia IM Nail Proximal 1/3 model – Need to find “correct” start point Hint- not the pre drilled one on model – Will need reduction aids- Clamp Unicortical plate Blocking screws Combination

10. Tibia IM Nail Your table instructors will help you out Please thank our representatives from Smith and Nephew for providing: – Equipment – Labor – Expertise