Opening the Medullary Canal
Click on image for enlarged view
Make a longitudinal incision over the patellar tendon, and retract the
tendon laterally. (In some patients, a patellar tendon-splitting
technique may be used to access the entry point.) Using the Universal
Chuck with T-Handle, insert a 4.0 mm Centering Pin into the entry
point. Pass it distally, angled 15° in the sagittal plane to the axis of the
tibial shaft, into the proximal aspect of the medullary canal. A sterile
nail may be placed against the anterior aspect of the tibial crest to act
as a guide to the correct angle of insertion of the centering pin. Verify
placement with the image intensifier. Pass the 11.0 mm Cannulated
Cutter and Protection Sleeve over the pin. With the Protection Sleeve
pressed against the bone, manually rotate the cutter to carve the
opening into the medullary canal. Tighten the setscrew at the base of
the cutter handle onto the pin, and remove the cannulated cutter,
sleeve and centering pin.
Note: For pseudarthroses or hypertrophic nonunions, use the hand
reamers sequentially to open the canal.
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