Date: Mon, 1 Oct 2001 17:41:55 +0600
Subject: Most popular size of unreamed nails
From: Alexander Chelnokov
Hello All,
I have to prepare an order for implants (unreamed tibial and femoral nails) so i am interested in what lengths and diameters are most widely used to request proportional numbers of implants of different sizes.
THX in advance.
Best regards,
Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Date: Mon, 01 Oct 2001 06:46:28 -0500
From: Adam Starr
Hi Alex,
Don't y'all have any reamers?
Adam Starr
Dallas, Texas
Date: Mon, 1 Oct 2001 18:49:53 +0600
From: Alexander Chelnokov
Hello Adam,
AS> Don't y'all have any reamers?
No one tibial and only very old rigid ones 10, 11 and 12 mm which were used for reaming from fracture site in open femoral nailing. Though i have used them for antegrade closed nailing to ream the isthmus.
Best regards,
Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Date: Mon, 01 Oct 2001 08:56:21 -0400
From: Kevin Pugh
Buy fewer nails and invest in a reaming system. As Michael Douglas (as Gordon Gecko) said in "wall Street", "Reaming is good".
Date: Tue, 2 Oct 2001 17:11:59 +0600
From: Alexander Chelnokov
Hello Kevin,
Monday, October 01, 2001, 6:56:21 PM, you wrote:
KP> Buy fewer nails and invest in a reaming system. As Michael Douglas (as Gordon Gecko) said in "wall Street", "Reaming is good".
Maybe due to this he was arrested finally Best regards,
Alexander N. Chelnokov
Date: Mon, 1 Oct 2001 07:39:35 -0700
From: John Ruth
Why unreamed? Most popular diameters of reamed tibial include 9, 10, and 12
(8 mm too small in my opinion) and femur include 10, 11 and 12 femoral.
Lengths of tibial 32-38 and femur 36-42 cm. This is my experience. The
smaller diameters can be used unreamed. If you are considering using
locking femoral rod in pediatric femur then should also stock 9 mm diameter.
Date: Tue, 2 Oct 2001 00:38:22 +0600
From: Alexander Chelnokov
JR> Why unreamed?
Most available implants for us became "imitations" of AO's UFN and
UTN made in Russia. At least the sets include conductors for proximal
locking.
JR> Most popular diameters of reamed tibial include 9, 10, and 12
(8 mm too small in my opinion) and femur include 10, 11 and 12 femoral.
We used minimal reaming, the isthmus only, and used the same
diameters.
JR> Lengths of tibial 32-38 and femur 36-42 cm. This is my experience.
THX! Can percentage distribution of the lengths and diameters be
available somewhere? I don't want to order equal number of each size.
Our first 20 cases have just been done. At the short series one 38 cm
nail was used for four-five 40 cm nails, so maybe such a distribution
is calculated with more representative basis?
Best regards,
Alexander N. Chelnokov
Date: Mon, 1 Oct 2001 10:04:22 -0500
From: Frederic B. Wilson, M.D.
Dear Alex,
Ream!
Invest in reamers with wide flutes (i.e. not Synthes) and avoid the
duplication of having both reamed and unreamed nails. Most of the experience
I am hearing and we have had indicates that the advantages of reaming
outweigh the advantages of not reaming.
Fred Wilson
Date: Tue, 2 Oct 2001 01:14:59 +0600
From: Alexander Chelnokov
Dear Fred,
FBWMD> Ream!
Invest in reamers with wide flutes (i.e. not Synthes) and avoid the
duplication of having both reamed and unreamed nails.
Available options include the UFN/UTN-like nails and self-prepared
conventional solid nails drilled in a local workshop. So the choice is
not difficult.
FBWMD> the advantages of reaming outweigh the advantages of not reaming.
Well, we've been yet comparing not reamed vs unreamed but closed
interlocked vs open conventional, plating and external fixation.
And in cases of sub-isthmal fractures i performed minimal reaming of
isthmus to fit the nail by old rigid reamers.
Best regards,
Alexander N. Chelnokov
Date: Tue, 02 Oct 2001 07:27:51 -0500
From: Adam Starr
Hi Alex.
I think every surgeon who has replied to your message has recommended that you
use reamed nails. That's because the experience over the past decade and a half
has shown us that for most instances, reaming is better. There are a lot of
reasons why.
Unless there is a HUGE cost difference for your hospital, I think buying a
reamer and using reamed nails is the way to go. You could probably offset the
extra cost of the reamer set by cutting down your nail inventory. 90% of the
femoral nails I place are 12mm wide. I need some smaller ones on hand for small
people, but the vast majority will take a 12.
Using only unreamed nails sets you at a disadvantage.
If you're coming to the OTA this year, maybe you could go shopping for a
reamer set? I bet you could find a vendor who would give you a deal - in the
interests of Russian-American friendship :).
Adam Starr
Date: Tue, 2 Oct 2001 19:34:59 +0600
From: Alexander Chelnokov
Hello Adam,
AS> I think every surgeon who has replied to your message has
recommended that you use reamed nails.
I realize that, and also i read some articles about the advantages of
reamed nailing.
AS> Unless there is a HUGE cost difference for your hospital, I think
buying a reamer and using reamed nails is the way to go.
The situation AFAIK is literally as you told - a huge cost difference.
AS> 12mm wide. I need some smaller ones on hand for small people, but
the vast majority will take a 12.
Do you mean femoral?
AS> Using only unreamed nails sets you at a disadvantage.
As i told, i ream isthmus by a rigid straight reamer. For femur 11-12 mm
is most useable size.
AS> If you're coming to the OTA this year
It is still too expensive for me. Though this year I already sent an
abstract, maybe late - received only automatic confirmation and not
aware was it accepted.
AS> maybe you could go shopping for a reamer set?
I suppose prices there must be even higher.
AS> I bet you could find a vendor who would give you a deal - in the
interests of Russian-American friendship :).
Say them hi and let they visit us here - they'll have a lot of
friendship ;-)
Best regards,
Alexander N. Chelnokov
Date: Tue, 02 Oct 2001 13:22:43 -0500
From: Adam Starr
Hi Alex.
Yes, 12mm is for femur nails. I think my most common tibial sizes are 9,10 and 11.
Let me see what I can do as far as finding out about the cost of reamer
systems. Russia is what they call an "emerging market" I think. Maybe they'd look
on the reamer set as an investment?
Adam
Date: Wed, 3 Oct 2001 00:47:06 +0600
From: Alexander Chelnokov
Hello Adam,
AS> Yes, 12mm is for femur nails. I think my most common tibial sizes are 9,10 and 11.
We received few UTN implants with the set for insertion - 8, 9 and 10
mm. We've never nailed any tibia before, tomorrow sheduled the first
case. Like a first kiss...
AS> Let me see what I can do as far as finding out about the cost of
reamer systems. Russia is what they call an "emerging market"
Some vendors already have small offices in Moscow. Mathys/Synthes is
most agressive AFAIK.
Best regards,
Alexander N. Chelnokov
Date: Wed, 3 Oct 2001 22:36:42 +0530
From: Dr. Rajat Varma
Dear Alex,
I would like to share my experiences with you regarding interlocking
nailings for we have faced & overcome the similar problem which are
confronting you now.
In early ninties Interlocking nailing came to India. But the problem was
the high costs of implants & instrumentations. We came up with our own
designs of implants and instrumetation and now can honestly claim to have
good quality implants at fraction of the costs eg A tibial or femoral nail
for US $ 30 ( Yes it is thirty and not three hundred ! ). At this price
range we have Recon Nail / Gamma Nail / Femoral Nail / Supracondylar Nail /
Proximal Tibial Nail / Tibial Nail / Distal Tibial Nail / Humeral Nail.
These all are cannulated. We also have Solid femoral & Tibial Nail which we
use in compound fractures and in infected non union situations. With such
long list of implants in different sizes available my stocking policy is as
follows.I put 9mm nail in tibia and 11mm nail in femur as a routine. I find
that the nail of this size has adequate strength for indian pateints to
mobilize full weight bearing in immediated post operative period. These
nails are made of 316L stainless steel and have 2.4mm wall thickness as
opposed to 1.2-1.5 wall thickness of AO and other western nails. I stock 9mm
tibial nails in 30/32/34/36/38mm sizes and 11mm Femoral nail in
38/40/42/44mm sizes.
Another point I want to share in nail selection is to only use a nail with
Proximal Dynamic hole and only to carry out single proximal dynamic locking.
This allow about 5mm of collapse at the fracture site on weight bearing and
helps in fracture healing.
I hope you find this useful.
Rajat Varma FRCS
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Tulane Orthopaedics
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Dallas
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Indore, INDIA.