Tibial Nail Advanced System (TN-Advanced™ System)  

The TN-Advanced™ Nails increase construct stability while reducing the number of screws required compared to conventional nails without polymer inlay such as the EXPERT NAIL™ Tibial Nails1,2. As part of the Advanced Nailing System, it is also designed with increased fixation1,2, patient satisfaction3 and intuitive, connection instrumentation to support infra-, supra-, and parapatellar approaches.4,5

Tibial Nail Advanced System (TN-Advanced™ System)

Features & Benefits

The tibial nail

Muliplanar Locking Pattern

  • Five multiplanar options - three most proximal screws within 30mm of nail top.
  • Four multiplanar options - three most distal screws within 22mm of nail tip.
Locking polymers

Angular Stability

  • Locking Polymer is built into the nail for angular stability in all distal locking screws without additional steps, end caps, or special instruments.1,2
  • Designed to avoid the challenges associated with cross-threading and cold-welding.1,2
Secure Retaining Screws

Secure Retaining Screws

  • Enlarged diameter of last few threads contributes to increased pull-out strength, more tactile feedback, and 92% higher torque before stripping in poor bone compared to a conventional EXPERT NAIL™ Locking Screw.6
  • Thread design resulted in 27% increase in bone purchase, compared to conventional EXPERT NAIL™ Locking Screws.6
Low Profile Locking Screws

Low Profile Locking Screws

  • Low-profile locking screws with rounded distal tips are designed to reduce implant prominence in areas of minimal soft tissue coverage.6,7
  • Low profile screw and thread design resulted in 42% increase in pull out strength in poor bone, compared to conventional EXPERT NAIL™ Locking Screws.6
The suprapatellar sleeve

Suprapatellar Compressive Sleeve

  • Compressible sleeve reduces pressure on the patello-femoral joint (PFJ) up to 70%, compared to solid sleeve design.8
  • Provides soft tissue and cartilage protection during opening, reaming, and nail insertion.5,9
a semi-extended parapatellar nail insertion

Parapatellar- Ergonomic Opening Awl and Insertion Handle

  • Ergonomic opening awl and specific insertion handle designed to support semi-extended parapatellar nail insertion and protect soft tissue.10
A shared base of instruments

Intuitive, Connected Instrumentation

Shared Base Instruments provide consistency to support reduction in storage, duplication and staff learning.11

  • Secure retention instrumentation - Solid “screw to screwdriver” connection. Same drivers used for both screws, available in manual and power6
  • Quick connect latch – efficient assembly/disassembly12
  • Twist and lock – protection sleeves secured in aiming arm11
  • QUICK CLICK® Self-Retaining Technology designed for facilitated attachment of nail to insertion handle10

Resources

Supporting Documentation

Resources

References

  1. DePuy Synthes biomechanical test report for TN-Advanced™ Nail. 8/13/2020. Windchill Document #0000305118
  2. DePuy Synthes description of locking polymer in TN-Advanced™ Nail. 8/17/2020. Windchill Document #0000305648
  3. Chitnis AS, Vanderkarr M, Ray B, Holy CE, Hughson S, Blauth M. Reoperations after intramedullary fixation of tibial fractures. Value in Health. 2020;23(1):185. doi: 10.1016/j.jval.2020.04.559.
  4. DePuy Synthes Advanced Nail System summary. 8/17/2020. Windchill Document #0000302373
  5. DePuy Synthes design validation report for TN-Advanced™ System. 7/16/2020. Windchill Document #0000294357
  6. DePuy Synthes test result summary for Secure Retaining Screws. 8/17/2020. Windchill Document #0000295306*
  7. Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg Br. 2006 May;88(5):576-80. doi: 10.1302/0301- 620X.88B5.16875. PMID: 16645100.
  8. DePuy Synthes contact pressure test report for suprapatellar protection sleeve. 8/17/2020. Windchill Document #0000305720
  9. TN-Advanced™ Nailing System Surgical Technique Guide for Suprapatellar Approach. 09/2020. Adaptiv Document #103711826, Agile Document Number SE_814686
  10. DePuy Synthes design validation report for TNAdvanced™ System. 7/16/2020. Windchill Document #0000294357
  11. DePuy Synthes Advanced Nail System summary. 8/17/2020. Windchill Document #0000302373
  12. DePuy Synthes usability evaluation for TN-Advanced™ Instrumentation. 8/18/2020. Windchill Document #0000305666

*Bench testing may not be indicative of clinical performance.

Indication Statement

The Tibial Nail Advanced implants are intended for treatment of fractures in adults and adolescents (12-21) in which the growth plates have fused. Specifically, the implants are indicated for:

  • Open and closed proximal and distal tibial fractures
  • Open and closed tibial shaft fractures
  • Tibial malunions and nonunions

WARNINGS

  • It is critical to ensure proper selection of the implant meets the needs of the patient anatomy and the presenting trauma. Physician should consider reaming to avoid under-sizing, to improve fit of nail, and to accelerate bone healing.
  • Use of these devices is not recommended when there is systemic infection, infection localized to the site of the proposed implantation or when the patient has demonstrated allergy or foreign body sensitivity to any of the implant materials.
  • Physician should consider patient bone quality to ensure it provides adequate fixation to promote healing.
  • Conditions that place excessive stresses on bone and implant such as severe obesity or degenerative diseases, should be considered. The decision whether to use these devices in patients with such conditions must be made by the physician taking into account the risks versus the benefits to the patients.
  • Compromised vascularity in the site of proposed implantation may prevent adequate healing and thus preclude the use of this or any orthopaedic implant.
  • Physician should take into account an increase in medullary pressure occurring during medullary nailing or reaming. This releases varying amounts of bone marrow and fat into the venous blood system.

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