Manca, md short proximal humeral nail long proximal humeral nail removal of the handle and closure diaphyseal humeral nail. Exactech prosthetic proximal humeral fracture repair surgical technique. Other medical or surgical conditions which would preclude the potential benefit of surgery. In addition, we demonstrate the use of a pushpull screw to aid in achieving appropriate compression across a.
Carbofix humeral nail for the treatment of fractures of the humeral shaft. Surgical techniques for the implanting of the biotech humeral nail. The retrograde nail length is determined by measuring the distance from 1cm above the olecranon fossa to the center of the humeral head. Although based on the wellknown t2 platform, the t2 proximal humeral nail design incorporates a number of unique features. The proximal humeral nail includes four proximal screws providing multiple locking options in the head of the humerus. While they are provided together for convenience, a plate and a nail should not be used on the sam. The nails are inserted using an opened or closed technique and can be static, dynamic and compression locked. As a result, surgeons witnessed the appearance of a wide variety of humeral. Multiloc humeral nailing system surgical technique depuy synthes. Loss of fixation or nail breakage after rigid intramedullary nailing was not observed in any of the studies. Humeral nail specification, uses, sizes and surgical. In the presence of a tumor defect, completed humeral shaft fractures continue to be a major surgical challenge since there is no gold standard treatment. Multiple fluoroscopic images of the arm in various positions must be obtained to confirm that the nail is below the horizon of the humeral head and adequately countersunk by a 3.
Versanail humeral universal nailing system contents note. Trigen humeral nail surgical technique pdf writer telegraph. The compliance of the nail construct was adjusted by overdrilling the near cortex reliable fracture union since the surgeon can. Effects of different surgical techniques on middistal. Modern proximal humeral nail designs and techniques assist the surgeon in adhering to these principles and. Precicenail introduction humeral deformity and shortening have both functional and esthetic implications leading to surgical intervention 22. With multiplanar screws that are threaded into the nail to inhibit proximal screw backout, and effective, simple. Management of humeral shaft fractures abstract humeral shaft fractures account for approximately 3% of all fractures. Im lengthening nails can provide successful and safe humeral lengthening. A threefold increase of these fractures is expected by 2030 when compared to the incidences in 19983. Surgical treatment of traumatic pediatric humeral diaphyseal. The nail is driven below the cortical surface of the humeral head to prevent subacromial impingement and rotator cuff irritation figure 5.
Pdf intramedullary nailing of the proximal humerus. Classifying humeral nails despite many differences in design and intended surgical technique, humeral nails can be grouped. In either approach, the surgeon should consider the appositioncompression feature of the t2 humeral nail, knowing that 6mm of active apposition compression is possible, prior to deter. The order of insertion of proximal and distal screws relies on fracture types and. Two different techniques are currently available for intramedullary nailing of humeral shaft fractures. Intramedullary nailing for displaced proximal humeral. This system offers a complete portfolio of implants and instruments, which treats a wide range of humeral fractures using simple and efficient instrumentation. Apr 21, 2017 this feature is not available right now. The proximal interlocking process might harm branches of the axillary nerve. This study was aimed at comparing the outcomes of these surgical techniques in terms of the vascular integrity of the middistal humeral shaft. In both surgical approaches, the special hole geometry of the nail ensures an optimal position of the locking holes.
Humeral shaft fractures are generally managed with the conventional posterior open reduction and internal fixation orif or minimally invasive plate osteosynthesis mipo. Features and benefits proximal locking locking screws. New intramedullary nail for the surgical neck fracture of the. In addition, we demonstrate the use of a pushpull screw to aid in achieving appropriate compression across a fracture site.
Screw intramedullary nailing for fractures of the humeral. The multiloc depuy synthes humeral nail short was introduced and approved for use in our local healthcare setting since the beginning of 2014. Multiloc humeral nails provide a comprehensive system for the treatment of humeral fractures. The aequalis humeral nail can be used either percutaneously or in open surgery. Mar 14, 2017 open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge.
Furthermore, the development of the t2 humeral nailing system offers the competitive advantages of. Standard interlocking surgical technique osteotomy osteotomies can be performed under carm guidance to correct the existing deformities. The system is comprised of instrumentation to perform both plate and nail surgeries. Modern proximal humeral nail designs and techniques assist the surgeon in adhering to these principles and have demonstrated promising. Solid humeral nail uhn and proximal humeral nail phn. Carbofix proximal humeral nail for the treatment of fractures of the proximal humerus. The biomechanical effect of torsion on humeral shaft. Surgical technique and early outcomes of intramedullary. We present indications, anatomic considerations, and surgical techniques used to surgically treat a transverse, midshaft humerus fracture through an anterolateral approach. Examples of specific indications according to ao classification include type afractures, dislo. Talon distalfix humeral talon nail htn surgical technique. The humeral nail system can be used with or without the sureshot distal targeting system.
The choice of which to use is dependent on the comfort. The main objective of this procedure is to anatomically reduce the tuberosities. Distal locking screws for the 18cm or longer humeral nails should be targeted using a freehand technique. The titanium elastic nail system technique guide original instruments and implants of the association for the study of internal fixation ao asif. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological. Options for surgical management of proximal humeral fractures have evolved continuously.
The t2 proximal humeral nail is intended for single use only. Surgical incision 8 venting of the femoral intramedullary canal 9 intramedullary reaming 9 antegrade femoral guide arm assembly 10. The order of insertion of proximal and distal screws relies on. Uhn can be used for an antegrade or retrograde insertion in the humeral shaft, and can be employed universally for the left and right humeri. This study was aimed at comparing the outcomes of these surgical techniques in terms of the vascular integrity of. Antegrade and retrograde femur operative technique. Surgeons may need to make modifications as appropriate in their own surgical technique with these devices depending on individual patient requirements. Download download trigen humeral nail surgical technique pdf writer read online read online trigen humeral nail surgical technique pdf writer official fulltext paper pdf. Good surgical fixation should entail anatomic reduction of the tuberosities and restoration of the. On the basis of the preoperative measurements, the humeral nail of the right length and thickness is chosen. Zimmer tea a tricepson approach to semiconstrained total elbow arthroplasty. The acumed polarus 3 solution has been designed to offer plate and nail options to treat proximal humerus fractures.
Twelve upper limbs were harvested from 6 fresh cadavers. The solid humeral nail uhn can be used for an antegrade or retrograde insertion in the humeral shaft, and can be employed universally for the left and right humeri. Biomet, as the manufacturer of this device, does not. The humeral nail and nail drill guide are keyed to ensure proper orientation of the nail on the nail drill guide.
This content is intended for health care professionals in the united states. In the first step, fit the driver bushing onto the nail. Over the last few years there have been several reports on the indications for humeral nailing, timing of the procedure, surgical technique, and. With cavitation of the humeral head fragment as a result of severe bone loss, internal fixation.
Nonsurgical management of humeral shaft fractures with functional bracing gained popularity in the 1970s, and this method is arguably the standard of care for these fractures. System is indicated to aid in the alignment and stabilization of humeral fractures, including. For fractures of the proximal humerus with diaphyseal extension and combined fractures of the proximal humerus and the humeral diaphysis, the three lateral screws greater. In both surgical approaches, the special hole geometry of the nail ensures an optimal position of.
The order of insertion of proximal and distal screws relies on fracture types and surgeons preference. Treatment of proximal humeral nonunion is one of the most difficult problems in shoulder surgery. The surgical technique is available through your local depuy sales representative. Humeral nail specification, uses, sizes and surgical techniques.
Surgical treatment of complex proximal humeral fractures with. Centronail humeral instruments box, complete 1789911. Russelltaylor humeral nail smith and nephew antegrade reamed 2328 t 2 stryker antegraderetrograde reamedunreamed uni. New intramedullary nail for the surgical neck fracture of. The t2 humeral nail offers multiple locking modes static, controlled dynamic and compression locking options to allow for ease of use and versatility in care. The modular implant system, consists of a short and long nail with multiple locking options, in order to address simple and complex fractures. Advance that nail which will most effectively pull. This brochure presents a surgical technique available for use with the biomet, inc.
The modular implant system, consisting of a short and long nail. The axis of the three bores are circumferentially offset in respect to each other in planes perpendicular to the longitudinal axis of the shaft. Uniflex humeral nail surgical technique zimmer biomet. This brochure is presented to demonstrate the surgical technique utilized by ralph b. Humeral lengthening with the precice magnetic lengthening nail. Step 3 step 2 step 1 the gap system can only be used for patients weighing 60 kg or less, or as. The innovative screwinscrew technology offers customizable stability for the individual patient. The system consists of short and long nails with multiple screw options to address simple and complex fractures of the proximal humerus as well as humeral shaft. Biomet, as the manufacturer of this device, does not practice medicine and. Small diameter intramedullary implant that requires only a 10mm. Humeral nails with multiple locking options for simple and. Humeral nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus.
Screw intramedullary nailing for fractures of the humeral shaft. The t2 proximal humeral nail is intended to be used for various types of proximal andor diaphyseal fractures of the humerus. Intramedullary nailing for displaced proximal humeral fractures. The surgeon must be sure that the nail is properly buried in the humeral head so that no impingement results from a proud nail. The subject and predicate devices are indicated for use in the humerus. Intramedullary nailing of humeral head and humeral shaft. T2 proximal humeral nailing system contributing surgeons. Instructions for use are found in the information that accompanied the product packaging. Thus, it is critical to define techniques and develop technologies for optimal management of humeral fractures. Fracture classification this surgical technique includes the surgical treatment of the following types of fractures. Various surgical procedures have been reported for their treatment. Interlocking intramedullary nailing for nonunion of the. Check the reduction and read off the nail length from the image of the ruler.
The t2 humeral nail is intended to provide temporary stabilization. T2 proximal humeral nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. Review article management of humeral shaft fractures. Surgical technique step1 begin by performing a resection of the humeral head and humeral canal preparation, as noted in the standard global advantage surgical technique cat. Specifically, the precice nail has accurate control over the lengthening process. New intramedullary nail for the surgical neck fracture of the proximal humerus in elderly patients article in journal of orthopaedic science 1. A humeral nail for the surgical care of fractures of the proximal humerus, with a shaft which has a longitudinal axis and is provided in a proximal portion with at least transverse bores spaced apart in the axial direction. With the multiloc humeral nailing system, synthes opens up opportunities for the treatment of humeral fractures. The incision approach that is recommended and most often used for antegrade humeral nailing is the lateral deltoid splitting. The proximal humeral nail includes four proximal screws providing multiple. This is due, in part, to the fact that only one prior biomechanical study exists on the matter, but which only compared 2 repair methods. Other medical or surgical conditions which would preclude.
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