Expert Nailing System (EX Nail) Instrumentation
The Expert nailing system range of implants is state-of-the-art, with several built-in features that optimize anatomical design and improve locking options, both equally important for successful treatment with intramedullary nailing. However, a thorough review of existing nailing instrumentation has revealed several clinical challenges: difficulty in determining the correct entry point, complexity in obtaining adequate fracture reduction, limited bone visibility due to metallic instruments, limited readability of measuring devices, and loss of screws in soft tissues during insertion. The need for a large number of instruments, which are not compatible with all nail types, makes inventory control a problem for hospitals. The new Expert nailing system (EX Nail) Instrumentation has been developed to address these issues and to optimize functionality, ergonomics, user-friendliness, durability, and ease of cleaning.
The new EX Nail Instrumentation is intended to be used with the Expert Lateral Femoral Nail (LFN-EX), Expert Adolescent Lateral Femoral Nail (ALFN-EX), Expert Retrograde/Antegrade Femoral Nail (R/AFN-EX) and Expert Tibial Nail (TN-EX) and is comprised of the following instruments:
- Radiolucent Insertion Handles and Aiming Arms
- Opening Instruments, Wire Guides, and Protection Sleeves with Handle
- Intramedullary Reduction Tool with T Handle
- Screwdrivers / Interlock Screwdrivers
- Measuring Devices
- Scalpel Handle
- Connecting Screw for Insertion Handle
- Cutter for the Expert Tibial Nail
- Handle (large) with Quick Coupling
- Combined Hammer 500g
- Driving Cap for Insertion Handle
Use of metallic instruments limits the surgeon's view during fluoroscopy, resulting in difficulty visualizing the fracture and the proper positioning of the locking mechanisms in the bone. The new insertion handles have an increased radiolucent area (Fig 1). In the US, the Standard Insertion Handle is used for the LFN-EX, R/AFN-EX, and Expert Tibial Nail. The shorter Dedicated Tibia Insertion Handle is optional for tibia procedures. Together with the radiolucent aiming arms (Fig 2), the visualization of the relevant bony anatomy on intraoperative x-ray images is improved (Fig 3). The new aiming arms have built in retention mechanisms and cam locks, which allow true-locking of the protection sleeves to decrease the risk of accidental loosening of the parts during the procedure.
Fig 1 EX Nail Insertion Handles for the individual nails. There is an optional percutaneous insertion handle available for the LFN-EX and R/AFN-EX. 
Fig 2 Radiolucent aiming arms with cam locks for R/AFN-EX retrograde (a) and antegrade (b) locking, Adolescent LFN-EX (c), and LFN-EX (d). 
Fig 3 Due to the radiolucency of the insertion handle, visualization of the bony anatomy is improved. Wire guide
Finding the correct entry point and path of the K-wire by trial and error can be cumbersome and frustrating. The new wire guides have a center hole and one or two offset holes. If the initial K-wire has not been inserted through the proper entry point, a second K-wire can be correctly placed in reference to the first wire through one of the offset holes (4 mm and/ or 6 mm from the central hole) of the instrument (Fig 4). The wire guide can be rotated in the protection sleeve and locked into four set positions with 90 axial offsets. This guide aids the insertion of a K-wire at the correct entry point (Fig 4c) when the first wire has been placed in an offset position. Color-coding limits the possibility of mismatching the instruments.
Fig 4ac Wire guide with offset holes to insert a parallel K-wire with a defined linear offset. Intramedullary Reduction Tool
Achievement of proper reduction, especially in femoral fractures, can be very challenging. A long reduction tool (Fig 5) has been developed, which has an anatomical curvature and a pointed fingertip to aid in fracture reduction.
The EX Nail Instrumentation has been developed based on surgeons needs in order to make the nailing procedure easier and more straight forward, to reduce OR time, and to improve results. The compatibility of the EX Nail Instruments also helps to reduce inventory and facilitates the OR set-up for a variety of procedures.
Fig 5ac Cannulated reduction tool with flat curved tip (a). The instrument allows for an easier reduction (bc) and reduces the amount of required x-rays. This will be beneficial in reducing OR time and x-ray exposure. 
AO ITC Innovations Magazine
Find all issues of the AO ITC Innovations Magazine for download here.
Innovation Awards
Recognizing outstanding achievements in development and fostering excellence in surgical innovation.