Surgical implants act as internal aids to normal healing and CAN’T bear the weight of the body when the bone is incompletely healed/not united. Surgical implants have offered the surgeon a means of rigid fixation for fracture management and reconstructive surgery. ONLY TRAINED ORTHOPAEDIC SURGEON should decide the use of correct implants & should do its fixation following an accepted surgical procedure.
I.SELECTION OF THE PATIENT
During the selection of patients, the following factors must be considered:
IMMUNOLOGICAL INTOLERANCE/ ALLERGY: Immunological intolerance or Allergy may occur in some patient. Where material sensitivity is suspected, suitable foreign body tests should be performed.
DEGENERATIVE DISEASES: In the case of patients suffering from degenerative diseases, it can get aggravated during implantation and will decrease the expected life of the implant. In such cases, surgery can be considered only as a temporary relief.
MENTAL ILLNESS: Mental illness or schizophrenia can cause patients to ignore the limitations as well as precautions of the implanted material, leading to implant failure and complication.
ALCOHOL AND DRUG ADDICTION: Patients who are addicted to alcohol and drugs may ignore during the state of stupor or during the stage of withdrawal, the essential precautions for the use of implants. This may lead to complications & implant failure.
OBESITY: An obese patient due to increased load, produce abnormal stresses on the implant which may ultimately result in its failure.
ACTIVITY: If the patient indulges in activity including significant muscular strain in the implanted region, then it can lead to failure of the implant.
SELECTION OF THE NAIL/WIRE: Nail/WIRE Selection prior to starting of the procedure is essential. The proper length of the nail is determined by radiographs of the opposite bone. The nail should extend well below the fracture site. Ideally, the nail should fill the major length of the medullary canal, and the nail should extend near to the full bone length.
For Femur Nail due to caudal curvature of the femur, caution must be used, so that distally the nail is not forced through the cranial cortex. Length of locking bolts should be determined with a calibrated drill.
III. CLEANING & STERILIZATION OF IMPLANTS
All Nails/WIRES are thoroughly cleaned before packing. Yet, it is recommended that before use, the nail/wire should be cleaned with clean water. It should then be sterilized by autoclaving for sufficient duration. Only then, it is ready for implantation by surgical procedure.
SUITABLE TARGETING DEVICE: Use of suitable guides for inserting Wire at the appropriate place and the correct angle is advisable. Similarly, the use of a targeting device for Proximal Locking is advisable. Targeting Device should be handled with care as rough handling may compromise the alignment and accuracy of the Instrument for subsequent use. Drill Sleeves should be replaced when worn out to maintain the accuracy of Targeting device.
POST OPERATIVE CARE: A patient must be informed to indulge in restricted muscular activity to assist in healing until the bone is united and weight bearing /normal muscular activity should be done after the bone union, strictly as per surgeon’s advice.
DO NOT REUSE IMPLANTS: Used implants which appear undamaged may have internal as well as external defects. It is possible that individual stress analysis of every part may fail to reveal the accumulated stress on the metals as a result of use within the body. This can ultimately lead to implant failure.
VII. DO NOT STERILIZE AGAIN
This symbol on the label implies that the Implant has been supplied duly sterilized by Gamma irradiation and should not be re-sterilized. In case the packing is damaged DO NOT use the implant.
VIII. DISPOSAL OF IMPLANT
Every orthopaedic implant must be discarded after use and should never be re-used. They should be bent & then disposed of properly so that they are unfit for reuse. While disposing of, ensure that the discarded implant does not pose any threat to children, stray animals & environment.