K- Nail For Tibia

 K- Nail For Tibia


  2. 1. K NAIL-HISTORY, DESIGN AND BASIC PRINCIPLES DEEPAK CHAUHAN (J.R.orthopaedics) MODERATOR-Prof.VIJAY G.GONI
  3. 2. History of Intramedullary nailing  The beginnings - sixteenth century In Mexico aztec clinical professional have Placed wood leaves in to the medullary trench of victims with extended bone non-associations.  Mid 1800s Ivory stakes had been embedded in to the medullary trench.  In 1917s-hoglund of the US expressed utilization of autogenous bone as intramedullary embed
  4. 3. Development of KÜNTSCHER NAILING  Gerhard Küntscher was once conceived in1900 in Germany.  Development happened all through World War-2(1939-42) while Germany was once at war, Küntscher was once sent as Chief clinical official in german armed force. The german naval force had the higher hand in treating officers with the IM nail and having return to threats notoriety in couple of weeks. Overall data was once not generally mounted Until detainees of battle again to their homegrown Countries conveying Kuntscher inheritance in design Of Steel nail in their legs.
  5. 4.  The methodology of femoral neck nailing depicted with the guide of smith - peterson has been improved by involving Küntscher for the nailing of extensive shaft bones.  His interesting intramedullary nail used to be a V-shaped spotless metal that was once embedded antegrade.  Küntscher previously articulated utilization of V-molded nail in 1940.  Early in the improvement of his technique,he empowered embedding the nail through an entryway distant from break site-contrasts from all employable crack strategies utilized before.  By late 1940-küntscher leave utilization of the V-formed nail diagram for some other plan the cloverleaf nail.
  6. 5.  Küntscher first nail in a human was once embedded in 1939 and expressed at school of Keil clinical society on dec 1939.  His methodology used to be truly obscure in U.S. at a few phase in fighting and used to be first Described in Quite a while march,1945,Time diary article,entitled"Amazing Thighbone".  Küntscher posted his first digital book in 1945 on intramedullary nailing.
  7. 6. Rule of KÜNTSCHER nailing (GERHARD B. G. KÜNTSCHER J Bone Joint Surg Am. 1958;40:17-26.)  The essential statute - stable osteosynthesis by means of - bendy impingement of nail in the bone - adequate grating of the nail in each break parts .  The contraption immovably encroached in the bone through flexible powers so that a craftsman's nail transforms into encroached in wood.  However the relationship truly does never again consent to in every single detail.  As in go section a craftsman's nail is almost rigid,when pushed in to wood,it pushes lumber aside.by qualification medullary depression is really inflexible; thusly to acquire versatile impingement,the move a piece of nail should be format to have flexibility with a V profile or significantly higher clover-
  8. 7. Drawings showing move segments of two sorts of intramedullary nails.the V nail is compressible in exclusively one direction,whereas the clover-leaf nail is compressible in two directions,these guidelines being legitimate points V - nail Cloverleaf nail
  9. 8. A SIMPLE EXPERIMENT DEMONSTRATES THE ELASTIC COMPRESSIBILITY OF THE CLOVER - LEAF NAIL. If a clover - leaf nail 12mm in width is introduced in to a vise,it can be compacted around three mm anyway will straight away get better its one of a kind shape,when sent off from the tight clamp.
  10. 9.  Use of this statute of flexibility will acquire the reasoning of entire and never-ending immobilization of the sections and presents an outright guarantee of bone union.There are two intentions in this: 1.Lateral movement can be killed exclusively assuming the nail involves the entire width of trench througout its length.this isn't possible with a solid bar which can as of now not be packed for different channel width.
  11. 10. A steady nail (left) will now not involve the full width of the medullary waterway in many areas considering the way that its measurement ought to be decided to in shape the tightest component of the channel. A nail with a versatile go region (right ) will alter to the tightening influences of the medullary trench. Strong nail Elastic nail
  12. 11. 2.The 2d thought process furthermore of uncommon significance. .Bone resorption will rapidly relax a solid rod(left),even despite the fact that at first this bar exactly in shape inward waterway. . Anyway nail with a compressible move region (right)will reach out for the span of bone resorption . This nail is intended to deliver the mechanical outcomes of bone resorption inadequate. Strong nail flexible nail
  13. 12. Plan femoral 'K' nail (THE TECHNIQUE OF INTRAMEDULLARY NAILING GERHARD KÜNTSCHER, MD and RICHARD MAATZ, MD Professor ReaderSurgeons, Department of Surgery, Kiel University Hospital  Cross segment generally V or cloverleaf framed  Sheet metallic thickness diminished on back-presents compressibility  Hollow center concedes data wire  Slot-anterolaterally uneasiness viewpoint  Eye-at each finishes  Common sizes-lengths-30,34,36,38,40,42cm width 8,9 and 10 mm  Protude no less than 3cm from trochanter  Standard femur K nail-
  14. 13. Unique plans  Tapered end-subtrochanteric crack  Y nail-peritrochanteric break  Some examples Saw tooth at its tip-for bone containing focal callus.eg-refracture,delayed association
  15. 14. TIBIAL NAILS  Double nails  Curved in structure  Cross area U shaped  Lengths-24-39 cm,at 1.5 cm increases most prominent width 8 and 9 mm  Two plans of spreading nail-Deflect to unfurl nail Rotate to unfurl nail
  16. 15. Divert to unfurl nail  Two nails spreads distally via capacity of a slanted airplane on external nail  The slanted plane on external nail and back mass of bone cylinder manages avoiding surfaces - cause inside nail to go in back way  Outer nail should be embedded first.  Resistant to bowing  Used in breaks distal to isthmus-long aberrant cracks or segmental bone loss(anterior edge).
  17. 16. Turn to unfurl nail  Also comprises two nails  Outer nail-standard example  Inner nail-roundabout pass part and a lethargic S structure  Inner nail must be embedded first  Only for cross over or brief aberrant fractures,bone loss(posterior cortex) A=outer nail B=inner nail
  18. 17. Instruments  Nail guide-solid,circular move part Length-64 cm,diameter-3mm  Awl-with an offset 4 sided tip  Impactor-works with addition of nail,allows hammer blows coordinated close by fundamental hub of focus part of nail. nail data Awl Tibial nail impactor
  19. 18.  Slotted hammer-most proper instrument for extraction even very organization situated nail  Kuntscher extractor-strung pole and Spring machine joins footing and mallet blows. assumption needs to reset with each blow Slotted hammer with extraction snare c b an a=threaded pole with becoming for hammer b=spacer=prevent bone mischief at instrument situation site online C=extension
  20. 19.  Reamers- Nail drinking spree grants nail contouring(other than femoral nails)
  21. 20.  Stepped scale-for radiographic commitment of medullary depression width  Reduction contraption
  22. 21. Situating
  23. 22. Küntscher arrangements:  1.if a crack is "nailable" it should be nailed.  2.nailing will be achieved in victims that are at novel peril whenever put away at sleeping pad unwinding in produced or on foothold.  3.nailing will be completed to control cracks that are famously difficult,such as simple cross over break.  4.one exceptional sign in unconstrained break of metastatic
  24. 23. Utilizes  Fractures-femur ,tibia,humerus,forearm,clavicle. Compound fractures,gun-fired cracks.  For non union,delay association.  Correction of malunion.  Congenital or aquired disfigurements  arthrodesis
  25. 24. Rules of nailing-cracks? Rules of nailing will depend on  type of the bone  Site of the crack  Pattern of break  There are no particular diminish - offs between reasonableness grades-therefore breaks are quality arranged as "entirely appropriate"- outright pointers "appropriate" "fringe" delayed side effects "unsatisfactory"
  26. 25. Intramedullary nailing is overwhelmed out in all intra-articular breaks :  nail may furthermore pressure parts to the side that are regardless in reasonable contact.  the machine will at this point not be in a situation to acquire an enough buy.  the joint may likewise be at risk from nail interruption.
  27. 26. Femur cracks nailing norms  Very reasonable cross over breaks and roundabout breaks with a short-piece medullary hole presenting no less than eight cm of "nail-appropriate" medullary depression.  Secure contrary to angulation,lateral uprooting and shortening.  Risk of pivot minimal in roundabout fracture,more with cross over break  Immediate weight bearing permitted
  28. 27. "Reasonable" cracks twisting breaks  appropriately firmly shut towards angulation and sidelong uprooting.  Shortening will occur with rotational malalignment-as spotless sections will slip past each unique when stacked.  No weight-bearing sooner than the stop of third week.
  29. 28. Inadmissible breaks  supracondylar crack with detachment of condyles(Y or T crack)-  Peritrochanteric breaks head stop of chic nail would never again secure sufficient purchase in trochanter..but they are extremely proper with Y nail.
  30. 29. Butterfly and segmental breaks  truly appropriate huge pieces with a bone imperfection on one feature OR non-communited 1/3 section in segmental crack. .Parallel dispalcement ruled out .tied down contrary to angulation. .shortening is presently beyond the realm of possibilities one viewpoint constant cortex. .prompt weight bearing
  31. 30. Communited cracks "reasonable"  resistant contrary to uprooting and angulation.  Great danger of shortening and malrotation.  Supplementary guide - skeletal foothold could likewise require  Weight bearing when sufficient callus framed.
  32. 31. Tibia cracks  Compared to femur - conditions are extra unfavorable.  Nail must be bended since.

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