CLAVOS INTRAMEDULARES

IM nails are used for the following type of fracture:

• A fracture involving the joint

• An intracapsular hip fracture

• A diaphyseal long bone fracture

IM nails require the following type of fracture reduction:

• Restoration of length, alignment and rotation

• Restauration through anatomical reduction

• Restoration through absolute stability

What is the purpose of the olive tip on the guide wire?

• To allow easy passage of the guide wire into the canal

• To prevent over reaming of the canal

• To prevent the reamer advancing to far

Mencione algunas ventajas del rimado intramedular:

Answer explanation

Increased perfusion and oxygenation in the adjacent

soft tissues

• Reaming debris has osteogenic and osteoinductive

properties

• Local “autografting” of bone debris into the fracture

site stimulates osteogenesis

• Systemic liberation of growth factors

• Allowing the insertion of larger (mechanically more

stable) diameter nail

Mencione indicaciones del bloqueo estático de un clavo:

Answer explanation

Static interlocking is used in severe fractures with rotational and/or longitudinal instability. It reduces compression or collapse in the fracture zone. Normally two or more bolts, depending on the type of fracture are inserted proximally and distally.

Mencione indicaciones y función del uso de bloqueo dinámico en un clavo:

Answer explanation

In simple shaft fractures dynamic interlocking is used. It increases compression in the fracture zone, controls rotational instability and encourages callus formation. One bolt only is used proximally and one distally in longitudinal elliptical slots.Weight bearing will allow the proximal bolt to move in the oval nail slot and encourages interfragmentary compression.Callus is formed.

Rimar ó no rimar?

Describa las características de rimar y no rimar un clavo:

Answer explanation

Reaming • Allows insertion of larger diameter nail • High union rates • Shorter healing process • Shorter procedure • Less damage to blood supply - • Endosteal blood supply is damaged • High pressure within IM cana

Nonreaming

Shorter procedure • Less damage to blood supply

Lower union rates • Longer healing process • More implant failures

Técnica del enclavijamiento intramedular: Consiste en al menos 6 pasos:

1. Complete los pasos en blanco:

Answer explanation

1. Reduction The fracture will be reduced closed, thus indirectly. In some cases, a fracture table may be used: e.g., fracture of the proximal femur, tibia shaft (less common), etc.

An external large distractor may help to achieve the reduction process in a gentle and controlled process.

2. Opening of canal The entry point is for each anatomical region defined and depends on the type of nail. Different nails require different entry points, particularly in the femur. It is important that the surgeon is aware of this as part of the planning process.

3. Reaming The correct reaming rod is inserted. The rod has a “ball tip” at the end and avoids loss of reaming heads in the intramedullary canal. The size and the length of the reaming rod depends on the type of the nail and reamer set. The rod for a femoral nail will be longer than for a tibial nail.

4. Nail insertion 1. The length and diameter of the nail can be determined. Intramedullarily  One reaming rod is pushed to the end of the medullary canal.  A second reaming rod of the same length is used outside the IM canal and held at the level of the entry point, just next to the first rod.  The difference between the two rods will determine the nail length.

5. Interlocking of the nail The diameter of the drill bit to be used depends on the diameter of the locking bolt and this may be different for each type of nail.

El punto de entrada determinará el recorrido del clavo por el canal intramedular.

Por lo tanto, encontrar y conocer el punto de entrada correcto es el paso más crítico del procedimiento. Si el punto de entrada es incorrecto, que puede pasar con el clavo?

Answer explanation

If the entry point is wrong, the nail may  deform the fracture site  get stuck  and even cause additional fractures. Other risks are:  Malalignment  Difficulty to insert the nail  Extension of the fracture  Problems with proximal locking  Articular damage

Nombre el término a este significado:

Es la extracción de uno de los tornillos durante el proceso de consolidación.

El movimiento adicional permitirá que se forme callo óseo, esto, en caso de un retraso en la consolidación.