Name:
TENS (Titanium Elastic Nail System) for Paediatric Femur Fracture
Description:
TENS (Titanium Elastic Nail System) for Paediatric Femur Fracture
Thumbnail URL:
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Duration:
T00H05M00S
Embed URL:
https://stream.cadmore.media/player/1d41db8f-9660-4379-a4b6-cf982842e7f5
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/1d41db8f-9660-4379-a4b6-cf982842e7f5/TENS (Titanium Elastic Nail System) for Paediatric Femur fra.mp4?sv=2019-02-02&sr=c&sig=may4m%2BQwJKKmpJmF03ZXHGfaNJGUQmTS4afYcpHo0CQ%3D&st=2024-11-21T14%3A55%3A34Z&se=2024-11-21T17%3A00%3A34Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hello, as today I'm going to demonstrate you a surgical operation which is called TENS nailing. This stands for titanium elastic nailing system. This is usually performed for pediatric population. And today's surgery is in a pediatric patient who has got a femoral sharp fracture. Now, I think one important thing when you are using a TENS nail is to determine the right size of nail to be put.
So if you look, I have done some marking here. So you have marked the inner aspect of medial cortex. We have marked in our aspect of the lateral cortex, and this is the diameter of the cortex. So say for example, diameter of cortex is 10 millimeter. So if you are using two TENS nails which is usually used in long bone fractures such as femur or tibia, and in that case, you are going to use 0.4 into 10.
So four mm into two. So you are going to use for 2 nails of four mm so that you fill around 80% of the canal. If it was say for example 8 mm, so again you are going to make 0.4. So 0.4 will be eight in 0.4 will be 3.2. So roughly three mm. So this is how you calculate the size of the nail. In single bone fracture, such as radius and ulna.
You aim for and you get around 60% of the canal you are aiming for. So if this was radius and I'm going to put one TENS nail. So I will divide 0.6 multiplied by ten, so I will use a single six mm. While this is just an example to explain you how to decide the size of the nail that you're going to put and always try to use two symmetrical nails that is nail of the same diameter if you want to use or if you want to follow the principles of TENS nail correctly.
So once your patient is prepped, draped and ready, you have to identify the site of insertion of the TENS nail. So this is usually two centimetres before the level of the physis. So you check it on X-ray and then only you make the stab hole so that your incision is at the right place. So one small tip when you are making your insertion is go at the 90 degree to the bone and then slowly start making your hole coming more and more vertical.
And that way you will not come out. Otherwise, when you go, when you start making your entry hole like this, you keep skidding on this ridge and you might struggle. So start vertically, start at 90 degree, and then drop your hand and go vertical. So we started at 90 degree. Now we have dropped our hand. I think we have made a good hole if next step will be to pass the nail.
Now there is a controversy whether to pre-bend the nail or put the nail straight away and let it follow the contours of the bone. I'll leave it for you to decide what you will do. I usually pre-bend the nail at the fracture site. And then only bypass it. So now nail is inside and this is one difficult point where you will find some difficulty. So because now nail has to go here and then travel up, this is the place where you will find resistance.
You just have to be patient. Just rotate your hand or use a mallet and tap it gently, and then you will find that this is going in the right direction. So now you can see after general tapping, this has gone in the right direction. So now you notice there is a bend at the tip of the nail and that is done purposefully because now you can see nail is going in this direction.
So all you are going to do is to redraw it slightly and rotate in the right direction and then gently hammer it and it should enter the proximal fragment. So now you can see we have withdrawn it slightly and the tip is now facing this cortex. And now if you gently tap it, it will go in the right direction. So either you can pass both wires medial and lateral and bring them here and tap them together one by one. So that you go and reduce the fracture or you can put one and then use other nail.
I usually find it putting one nail, give some stability and then passing the second wire, it becomes much easier for me. And also, don't tap this till more than lesser trochanter, because what you're going to do is you're going to cut the tail proud and then you will tap it.
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