INTERTAN NAIL PDF

The trapezoidal shape of the nail places more material at the lateral side of the implant where tensile forces are typically the strongest. What is an Integrated Interlocking Screw configuration and how will it help my patients? The integrated interlocking screws of the INTERTAN system increase stability and resistance to both intra and post-operative fracture rotation about the implant by providing two points of fixation within the femoral neck and head. This directly reduces rotational instability and eliminates the possibility of implant failure due to Z-Effect. The INTERTAN system incorporates the best aspects of both devices by providing both single and dual integrated lag screws for the treatment of most major fracture patterns. Z-Effect is an unfortunate by-product of most intramedually nails that utilize two screws placed up into the femoral neck and head.

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The trapezoidal shape of the nail places more material at the lateral side of the implant where tensile forces are typically the strongest. What is an Integrated Interlocking Screw configuration and how will it help my patients? The integrated interlocking screws of the INTERTAN system increase stability and resistance to both intra and post-operative fracture rotation about the implant by providing two points of fixation within the femoral neck and head.

This directly reduces rotational instability and eliminates the possibility of implant failure due to Z-Effect. The INTERTAN system incorporates the best aspects of both devices by providing both single and dual integrated lag screws for the treatment of most major fracture patterns. Z-Effect is an unfortunate by-product of most intramedually nails that utilize two screws placed up into the femoral neck and head.

Typically, the superior screw is of smaller diameter than the inferior and bears a disproportionate amount of load during weight bearing. Excessive varus forces placed on the smaller screw at the lateral cortex cause it to toggle and either back out or migrate through the femoral head into the acetabulum.

The larger inferior screw is neither keyed in rotation nor locked in place, and it too will either back out or migrate medially. The resultant Z-Effect where the two screws move in opposite directions is one mode of failure for the conventional two screw reconstruction device.

The INTERTAN nail turns that construct upside down and integrates the two screws so that they act as one device to bear all load, enact all compression and prevent excessive medial or lateral migration thus negating the Z-Effect. Why do I ream with a 16mm channel reamer and the nail size is larger? Upon its initial insertion into the proximal femur, the INTERTAN nail exerts a small amount of press-fit within the canal by virtue of its trapezoidal cross-section.

Once the correct degree of femoral neck anteversion has been determined, the nail can then be impacted into the proximal femoral metaphysis acting essentially as a broach to further enhance the initial press-fit. The 17mm reamer is available to accommodate those instances when dense bone is encountered such that it precludes that initial press-fit.

Why does the short nail have a clothespin distal tip? The clothespin distal tip of the INTERTAN short nail reduces the overall cross-sectional stiffness of the implant to minimize the risk of iatrogenic fracture during insertion, to ease the actual process of nail insertion and to offer enhanced rotational stability within the proximal femoral canal. This has the advantage of lessening point stresses about the distal tip of the nail and reducing the possibility of fracture due to a stress riser at that location.

If I only use the single subtrochanteric lag screw option does that create a stress riser at the empty inferior hole in the nail?

This is the same orientation used in the testing of femoral stems for total joint replacement. This is representative of approximately six months implantation time at which fracture union should have occurred.

Our mechanical testing data reveals no significant stress riser occurring at that point. I have been using a single screw IM device for the last 20 years and have yet to have one cut out. Do I have to use the integrated screws? Absolutely not. Our designing surgeons feel that rotational instability is a major contributing factor to that failure rate and propose the INTERTAN nail as the solution to this dilemma. The problem lies in the fact that even implants that are keyed to prevent rotation can still experience rotation of the fragments about the axis of the lag screw.

Placement of a secondary point of fixation into the femoral neck and head reduces the chances of rotation but adds the secondary concern of Z-Effect. Mechanical testing of the two screw construct was stopped at , cycles with no evidence of implant cut out, further reinforcing the INTERTAN nail philosophy.

Excessively lateral nail insertion can cause damage to the abductor muscle group, the effects of which are not entirely clear. Recent literature JOT Vol. They must be examined relative to the location of the offset, the AP bow of the nail and the location of the nail entry point in both the AP and LM planes in order to get a complete picture.

How do I know when to use the integrated interlocking screws vs. These fractures require enhanced fixation in order to maximize their postoperative stability, and single screw, keyed implants can still experience rotational instability about the lag screw.

The active linear compression driven by the integrated screws gives the surgeon clear visible and tactile confirmation of intraoperative fracture reduction. The dual screw option is ideal for unstable fractures or for those surgeons simply wanting enhanced confirmation of fracture reduction. No two fractures are exactly alike and so to say that one implant can adequately treat every injury is misleading. We want to appeal to as wide a customer base as possible and feel that we would be doing a disservice to our surgeons if we attempted to give them one nail to treat every fracture that walked through their clinic door.

IMHS CP hip screws are proven in the literature to out-perform the Gamma-type device in postoperative controlled sliding. Its lower coefficient of friction facilitates superior sliding of the lag screw within the barrel of the nail relative to other single screw devices to promote fracture healing.

The INTERTAN nail offers a two screw solution for enhanced rotational stability and active linear compression for visual and tactile compression of the fracture. The integrated interlocking screws provide superior life to cut out and so offer surgeons a viable treatment modality for highly unstable fracture patterns. Why do I ream with a 16mm reamer and the nail size is larger? This trapezoidal cross-section allows a larger diameter nail to fit into a smaller hole thus reducing the total amount of bone removed.

The trapezoidal vertices of the nail cause it to press-fit into the femoral metaphysis and provide enhanced rotational control vs. This is important in the proximal femur where maintenance of correct femoral neck anteversion during lag screw placement is essential to the prevention of implant cut out. Should the surgeon encounter very dense bone during nail insertion, the 17mm reamer will over-ream the proximal femur and allow the nail to slide more freely into the canal.

Some surgeons feel that the longer 20cm nail provides enhanced interference fit within the femoral diaphysis thus preventing fracture rotation about the nail.

Both implants have a straight profile, but the clothespin distal tip closes slightly as it encounters the AP bow in the femur in order to reduce point stresses about the nail tip. This has the advantage of reducing the likelihood of iatrogenic fracture of the femur at the nail tip due to a stress riser.

The same clothespin distal tip characteristics are available in the more frequently implanted 18cm nail as well. This information is intended for health care professionals only. Want more information?

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The trapezoidal shape of the nail places more material at the lateral side of the implant where tensile forces are typically the strongest. What is an Integrated Interlocking Screw configuration and how will it help my patients? The integrated interlocking screws of the INTERTAN system increase stability and resistance to both intra and post-operative fracture rotation about the implant by providing two points of fixation within the femoral neck and head. This directly reduces rotational instability and eliminates the possibility of implant failure due to Z-Effect. The INTERTAN system incorporates the best aspects of both devices by providing both single and dual integrated lag screws for the treatment of most major fracture patterns. Z-Effect is an unfortunate by-product of most intramedullary nails that utilise two screws placed up into the femoral neck and head. Typically, the superior screw is of smaller diameter than the inferior and bears a disproportionate amount of load during weight bearing.

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How is INTERTAN different?

References: 1. American Academy of Orthopaedic Surgeons. Hip fractures in seniors: a call for health system reform. Position Statement Rosemont, IL: Baumgaertner M, Solberg B.

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