Creating equality of
fracture care
throughout the world.
Interactive
SIGN workshop
 Craftsmanship
 Shared experiences
 Contemplation
Imaging
Fracture table
OR time
• Soft tissues
• Reduction
• Stabilization
When to nail?
Early nailing results
Approach-retrograde or antegrade
Type of nail-standard or fin
2 interlocking screws or one screw
• Position of patient
• Overlapping fracture
• Mini incision reduction-traction
preop
Delay in presentation
Delay in presentation
•Reduction slow
•Incise quad
Judge reduction
 Linea aspera
 What is optimum reduction for healing –
biological v. mechanical
 Does callus have BMP?
Minimal incision –
only expose 2 main fragments.
•
•
Through fracture site-avoid metaphysis
Over ream older fractures
Power v. hand SIGN
Bone graft
No second hit?
Greater trochanter versus piriformis
fossa
Hoop stresses
Show video
Reason reamer becomes stuck
Follow the track
Bone entrance
•
•
•
•
Bone entrance
Direction of interlock
Slow insertion
Depth
Allow rotation of the nail to occur
with no rotational force
Anterior Posterior
Lateral to Medial
1.
2.
Bone Entrance
Depth of nail
Slot orientation-longitudinal and rotational
Checkpoint
 Problem solving
 Checklist of reasons when the slide Finder
does not enter the slot in the nail.
•
Enlarge hole with screw hole
broach. Routine in hard bone
• Check reduction- reduction slip can
be longitudinal or rotational
• Screw hole broach
Distal Interlock
Fracture reduction has slipped
Nail has migrated
Distal Interlock
Rotation
After making hole in bone
Nail bends during insertion
Set up target arm
Bent nail.Why?
Straight and bent nails
Cannula is off the bone
Loosen target arm in the midportion
Swing the target arm over the bone
Drill the hole in the near cortex
SIGN sawbones workshop
Solid Slot Finder Stuck
Screw hole broach
Different techniques for
interlocking
Picture of the three
slot finders
Place curved slot finder
Remove target arm first
Rotate Curved Slot Finder to
find Slot
Curved Slot Finder in Slot
Rotate nail so curved slot finder answers slot
Compress the fracture site
Compression
Existing SIGN System
Extractor
Compressor
• Direction
• Number of screws
Circlage
No cerclage
51768
Shaft and neck
Subtrochanteric fracture
Flexion and extension of knee to see
knotch
Supine
60 degrees flexion?
Closed reduction
Approach through or medial to tendon
Length of nail
High stress area
Distal interlock
53218
Two Problems
TKI approach
Blocking screw
• Diagnosis
• Squat and smile
3 months
5 months
Use of SIGN nail for femur
fractures
57222
57761
Fractured femurs from knee
to hip
50375
50375
2 screws
Approach?
60921
60921
Manipulate knee in all patients
 End of surgery
 In rehabilitation
Must use L-Handle not just locking bolt
Broken equipment
 Locking bolt
 Drill bits
 Step drill
Locking bolt-loose
Locking bolt-loose
locking bolt-broken
Locking bolt-tight for
insertion and extraction
Broken locking bolt
Broken drill bit
Broken step drill