Beruflich Dokumente
Kultur Dokumente
The femoral, tibial and supracondylar nails in the JMF Nailing system are manufactured from unslotted, cylindrical closed-section high tensile
strength stainless steel. Superior torsional resistance of this design is an important advantage in comparison with conventional slotted designs.
A gentle taper at the tip allows easy insertion.
The JMF femur nails feature upward, transverse, downward and miss-the-nail locking options for ipsilateral fracture configurations. The same
nails are used for left and right femora reducing inventory and simplifying handling which are key benefits to operating surgeons and operating
room staff.
The JMF tibia nails have proximal locking screws which are oriented at 45° to the long axis of the tibia. These screws are safer to introduce than
conventional A-P screws and allow excellent purchase in the posterior cortices. All nails are constructed with a reinforced distal locking hole
which is located at the distal tip of the nail. This locking hole allows these nails to be used with more distal fractures when compared with most
systems. Small Diameter Nails Smaller diameter nails (Dia 9 & 10mm) are available for patients with small medullary canals. Modular design
instrumentation enables the insertion and locking of small diameter nails with the same instruments used for standard diameter nails.
New Generation Instrumentation the JMF system features specially designed insertion instrumentation with polymer shock-absorbing washers
which absorb impaction loads. The instrumentation is extensively tested for reliability in preventing thread loosening during nail impaction.
Indications the JMF femoral locking nail system can be used for a wide range of stable and unstable fracture configurations including
Femoral Nail
Length of proximally enlarged section of nail (all diameters) 85 mm
Diameter of proximally enlarged section of nail (9 and 10mm nails) 12 mm
Diameter of proximally enlarged section of nail (10 and 12mm nails) 14 mm
Distance of transverse locking proximal screw hole from proximal tip of nail 40 mm
Distance of distal tip screw hole from distal tip of nail 5 mm
Radius of curvature 3000 mm
Tibia Nail
Length of proximally enlarged section of nail (all diameters) 55 mm
Diameter of proximally enlarged section of nail (9 and 10mm nails) 12 mm
Diameter of proximally enlarged section of nail (10 and 12mm nails) 14 mm
Distance of first proximal screw hole from proximal tip of nail 30 mm
Distance between first two proximal screw holes 10.5 mm
Distance of distal tip screw hole from distal tip of nail 5.0 mm
Location of nail bend with reference to proximal nail tip 60mm
Bend angle (degrees) Dia 9 and 10mm 13°
Bend angle (degrees) Dia 11 and 12mm 6°
Supra-Condylar Nail
Length of proximally enlarged section of nail (all diameters) 39 mm
Diameter of proximally enlarged section of nail (9 and 10mm nails) 14 mm
Diameter of proximally enlarged section of nail (10 and 12mm nails) 14 mm
Distance of first distal locking hole from distal nail tip 20 mm
Distance of second distal locking hole from first distal locking hole 10 mm
Distance of most proximal locking hole from proximal nail tip 15 mm
Distance of second proximal locking hole from first 20mm
Location of nail bend (distance from distal tip) 45mm
Nail bend angle 8°
2 JMF (T)
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IM Implants IMN
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IM Implants IMN
Tibia Nail
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IM Instruments IMN
Instruments
12-1703 AWL
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IMN IM Instruments
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IM Instruments IMN
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IMN IM Instruments
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IM Instruments IMN
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IMN IM Instruments
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Technique Femur IMN
Surgical Technique
Preparing the Canal and Inserting the Femoral Nail
3 pushed past the fracture site, with the power drill in the “off ”
position, till the reamer crosses the site of comminution. The
last reamer used should be at least 1mm (ideally 1.5 – 2.0mm)
higher than the planned nail diameter. It may be necessary to
over-ream the proximal part of the canal 2.5 – 3.0mm higher
than the planned nail diameter to accommodate the proximally
strengthened part of the nail.
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IMN Technique Femur
4 the point of entry and reducing the same from the total length of
the wire.
Nail Insertion
Nail insertion is achieved using the following steps
6 the slots on the nail with the two prongs on the body
of the instrument and tightening the threads on the
Locking Bolt of the instrument with the internal threads
on the nail.
7 fastened.
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Technique Femur IMN
Insert the nail over the nailing guide wire and introduce
the nail by hand as far as possible.
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IMN Technique Femur
Distal aiming devices including the Guide Bush (12-1721), Aiming Trocar (12-1722), Homing Device, Femur (12-1723), Homing
Device, Tibia (12-1724) and Distal Aiming Device with Fibre Handle (12-1725) are available in the instrumentation to assist in
the distal locking process. Different types of distal locking screws are available with the system and are described below:
• Locking Screw 4.5mm, self-tapping: This screw requires both cortices to be drilled with a 3.5mm drill bit and over-drilling of
the near cortex with a 4.5mm drill bit. The 4.5mm shaft with distal threads provides higher resistance to shear loading. The
threads on the screw head enable this screw to be securely engaged with the Hex Screwdriver with Sleeve while insertion.
• Tibial Locking Screw 4.5mm, self tapping: This screw while designed for the tibia may also be used for distal femoral locking.
Faster insertion is possible as this screw is designed for direct insertion following 3.5mm drilling (both cortices). Insertion is with
a standard Hex Screwdriver (3.5mm a/f).
Proximal Locking
The femur nails allow proximal locking in three configurations. The steps to be followed to achieve proximal
locking in each of these configurations are described below.
Engaging the dense trabecular bone of the medial femur, this is the preferred locking option when allowed by the fracture
configuration. The additional benefit of this locking option is that prox mal locking can be achieved
by slightly extending the main nail insertion incision without creating a second incision for the proximal lock. Proximal lo-
cking with the 130°, downward locking screw is achieved with the following steps:
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Technique Femur IMN
13 Insert the Drill Guide, 3.5mm (12-1709) into the 130°, down-
ward locking hole and advance it to bone.
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IMN Technique Femur
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Technique Femur IMN
22 the near cortex and the nail hole without rotation and then
rotating clockwise to engage the self-tapping distal threads
with the distal cortex.
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IMN Technique Femur
Ensure that the Jig cum Nail Impactor is securely engaged with the implanted nail and is correctly oriented with the Locking Arm
oriented lateral to the nail.
Carry out an incision as necessary to achieve insertion of the Drill Guide for proximal locking, upto bone.
Insert the locking screw through the transverse guide hole on the Jig cum Nail Impactor by first advancing it through the
near cortex and the nail hole without rotation and then rotating clockwise to engage the self-tapping distal threads with the distal
cortex.
The instrumentation is designed to allow the placement of two Miss-a-Nail screws anterior to the nail and oriented upwards into the
femoral neck. Proper placement of the nail in the canal verified by image intensifier views to confirm expected placement
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Technique Femur IMN
Finally, the Locking Cap is threaded onto the proximal end of the nail
26 by engaging the threads of the Cap with the internal threads of the
implanted nail. A standard 3.5 a/f screwdriver is used.
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IMN Technique Tibia
1 cut centrally or retracted laterally. Access the diaphyseal canal using the
Diamond Pointed Awl (12-1701). The proximal insertion point
selected should be less than 1 cm distal to the anterior margin of
the tibial plateau. If the insertion point is too distal, damage to posterior
cortical bone could result.
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Technique Tibia IMN
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IMN Technique Tibia
Assemble the Tibial Locking Extension by tightening the Locking Bolt For Tibial
9 Locking Extension, first by hand and then using the Double Ended Spanner
(12-1716).
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Technique Tibia IMN
Image intensifier views may be taken to confirm correction positioning of the nail.
Distal locking is performed in the conventional mode with distal screws. The standard free hand technique for distal locking is recom-
mended.
Distal aiming devices including the Guide Bush (12-1721), Aiming Trocar (12-1722), Homing Device, Femur (12-1723), Homing Device,
Tibia (12-1724) and Distal Aiming Device with Fibre Handle (12-1725) are available in the instrumentation to assist in the distal locking
process. Different types of distal locking screws are available, and are described below:
• Locking Screw 4.5mm, self-tapping: This screw requires both cortices to be drilled with a 3.5mm drill bit and over-drilling of the near
cortex with a 4.5mm drill bit. The 4.5mm shaft with distal threads provides higher resistance to shear loading. The threads on the screw
head enable this screw to be securely engaged with the Hex Screwdriver with Sleeve while insertion.
• Tibial Locking Screw 4.5mm, self tapping: This screw while designed for the tibia may also be used for distal femoral locking. Faster
insertion is possible as this screw is designed for direct insertion following 3.5mm drilling (both cortices). Insertion is with a standard
Hex Screwdriver (3.5mm a/f).
Proximal Locking
Proximal locking with tibial nails is achieved with two proximal locking screws oriented at 45°
to the A-P plane as illustrated.
• The distal threads of both proximal locking screws engage in the dense postero-medial and
postero-lateral cortices of the tibia. This provides more secure holding when compared with
medio-lateral locking screws
• The inclined drilling that is required for placement of these screws is safer as it eliminates
the risk to posterior neurovascular structures associated with antero-posterior drilling for A-P
screws Tibial locking is performed with 4.5mm Tibial Locking Screws with low profile screw
heads. These screws are self-tapping with a core diameter appropriate for direct insertion
following drilling with a 3.5mm drill bit.
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IMN Technique Tibia
14
Insert the Drill Guide, 3.5mm (12-1709) into the proxi-
malmost locking hole and advance it to bone.
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Technique Tibia IMN
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IMN Technique Supracondylar
Supracondylar Nailing
The Supracondylar Nail is a non-slotted smooth, cylindrical nail with proximal and distal holes. The 8° angle allows for better seating
of the implant within the femoral canal and also allows percutaneous insertion without interfering with the patella or patellar ten-
don. The proximal (insertion) end of the nail features internal threads, which securely couple with the instrumentation and also allow
engagement of a threaded locking cap.
Point of entry
The point of entry is located, just anterior to the insertion of the posterior
cruciate ligament. This point is identified as the co-ordinate at the junction
of the antero-posterior line drawn through the deepest part of the trochlear
groove and the medio-lateral line connecting the two epicondyles.
Incision
Nailing can be done either through a formal open approach or through a percutaneous approach. For the formal open approach, a
medial para-patellar incision is taken and the patella is dislocated laterally.
The percutaneous approach is done through a 2 cm incision distal to the inferior pole of the patella and medial to the patellar
tendon. The infra-patellar fat pad is retracted, a steinman pin is inserted and the point of entry is localized with the help of a C-arm
image intensifier.
1
Make the initial entry with a Diamond Pointed Awl
(12-1701). Take care to ensure that the direction of the
tract is in line with the medullary canal of the femur.
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Technique Supracondylar IMN
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IMN Technique Supracondylar
Nail insertion
6
Disassemble the Driver for Jig Assembly, supracondylar
by unthreading it from the main body of the jig to
expose the proximal end of the Nail Locking Bolt.
7
aligning the slots on the nail with the two prongs on
the body of the instrument and tightening the threads
on the Locking bolt of the instrument with the internal
threads on the nail. Ensure that the apex of the angle
in the nail faces anterior-wards for correct nail place-
ment.
8
securely fastened.
9
Reassemble the Driver for Jig assembly, supracondylar
to the main body of the instrument.
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Technique Supracondylar IMN
Insert the nail over the nailing guide wire and introdu-
ce the nail by hand as far as possible. If some impac-
tion is found to be necessary, thread the Nail Impac-
tion/Extraction Assembly (12-1717) to the proximal
10 end (Driver for Jig Assembly) of the Jig.
The Guide Bar of the Jig cum nail Impactor features four proximal holes. The two most proximal holes are used to lock the
200mm nail. The next two holes are used to lock the 150mm nail.
Use the following steps to carry out proximal locking after making an appropriate incision –
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IMN Technique Supracondylar
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Technique Supracondylar IMN
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Distributed by :
01-0002
Rev. 1.0.1