- Engaging the Nail Jig:
- position the insertion block on to the proximal end of the nail;
- position insertion handle onto insertion block so it will be medial to tibia for nail insertion and precise placement of proximal locking;
- note that the proximal nail tip passes inside of the proximal jig and this corresponds to transverse black line on the outside of the jig;
- this line demarcates the proper depth of nail insertion;
- oblique aiming handle attaches to insertion handle, after insertion of the nail and removal of insertion/extractor, and is used for aiming of an oblique proximal locking bolt;
- used for proximal metaphyseal fractures;
- for more proximal fractures, the oblique aiming handle allows placement of an oblique proximal locking bolt in either the anteromedial to postero-lateral
or anterolateral to postero-medial direction;
- Locking options:
- oblique locking hole close to proximal nail end allows locking of proximal metaphyseal fracture;
- dynamic slot
- transverse locking hole for standard interlocking
- two distal M-L locking holes, w/ third hole in the AP plane for perpendicular bolt fixation of low tibial fractures;
- the 10 mm Nail uses standard 4.9 mm bolts;
- use the 4.0 mm drill bit for predrilling;
- the 8 and 9 mm Nail uses standard 3.9 mm bolts;
- 3.9 mm Titanium Locking Bolt:
- the 8 and 9 mm Nail uses standard 3.9 mm bolts;
- low head profile for areas with minimal soft tissue coverage;
- core diameter of 3.3 mm;
- Proximal Inter-Locking:
- prior to proximal inter-locking, ensure that nail has been inserted down to the proper level;
- w/ the insertion handle oriented medially, make a stab incision thru thru the skin below the selected aiming hole;
- the gastrocnemius muscle should be pulled posteriorly beforehand;
- insert the 8.0 mm trocar into the 11 mm/8 mm protection sleeve;
- remove the trocar and insert the 3.2 mm drill sleeve;
(if 10 mm nail has been inserted, use an 8.0 mm/4.0 mm drill sleeve and a 4.0 mm drill bit to insert the 4.9 mm bolt;
- after drilling the near cortex, stop drilling the far cortex, read the bolt length on the drill bit, then finish drilling;
- add 4 mm to the measurement length;
- note that because the proximal tibia has triangular configuration, properly inserted
screws may appear short (due to the radiographic overlap of the posterior tibia);
Peroneal nerve damage associated with the proximal locking screws of the AIM tibial nail.
Anatomical study of the placement of proximal oblique locking screws in intramedullary tibial nailing
