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Synthes Tibial Nail: Proximal Interlocking


- 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;
    - 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 by oblique proximal locking screw in tibial fracture nailing: a new emerging complication?

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

Vascular injury involving proximal medial-to-lateral oblique locking screw insertion in tibial intramedullary nailing.

Dynamisation and early weight-bearing in tibial reamed intramedullary nailing: Its safety and effect on fracture union.