We propose a standardized and reproducible technique that we apply to all complex displaced 3 and 4part fractures of patients under 50 years. Ncb proximal humerus plating system surgical technique 2121 7. Surgical stabilization of humeral shaft fractures in children, when indicated, can. However, anatomic alignment of humeral proximal fractures depends upon the position of the entry site, the angle of the entry nail and the pathology of the humeral head fracture, if present. The mean age was 10 years old at the time of surgery, with a range from 7 to 12 years.
With cavitation of the humeral head fragment as a result of severe bone loss. Mar 16, 2009 twentyfour proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. Open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. Interlocking contoured intramedullary nail fixation for. Distal humeral fractures associated with previous prosthetic nail present a challenge to the surgeon to obtain satisfactory results. The fda just cleared orthopedic designs north america, inc. Distal humeral fracture fixation with an extensor mechanismon approach jason m. Introduction open treatment of extraarticular and intraarticular distal humeral the fractures can be effectively accom.
At present, both of these surgical approaches are used to treat humeral shaft fractures. Humeral nail system cleared in under 30 days orthopedics. Proximal humerus fractures foundation for orthopaedic. Make sure there is no blood in the screwdriver cannulation since this may push the kwire forward. Proximal humeral nail diaphyseal humeral nail 79 mm 5. Surgical treatment of complex proximal humeral fractures. The humeral nail of medimetal was developed to treat variously located diaphyseal fractures. Proximal humeral fractures and intramedullary nailing. There were 19 males and 4 females, 15 with right arm fractures and 8 with left arm fractures. Jun 29, 2017 demonstration of performing proximal humeral fracture fixation with nailing using multi directional locking proximal humerus nail. This metaanalysis compared the clinical outcomes of locking plate with intramedullary nail in the treatment of displaced proximal humeral fractures. Techniquenail insertion for pediatric femur contouring the nail additionally available item contouring may be done by hand or with the tabletop platebending press 329.
Check the reduction and read off the nail length from the image of the ruler. The trigen humeral nail system is indicated for proximal andor diaphyseal fractures of the humerus, nonunions, malalignments, pathological humeral fractures. The agency received the clearance request on january 26, 2018 and notified the company on. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. Surgical management of fracture shaft of humerus in adults. The trigen humeral intramedullary nail brings the simplified instrumentation of the trigen nail system to the hindfoot. The uniflex humeral nail system was developed in conjunction with ralph b. Chief of surgical services, medical director of murnau trauma center. The aequalis humeral nail can be used either percutaneously or in open surgery.
Introduction incidence of fracture of the humerus shaft is between 3% and 5% of all fractures1,2. The titanium flexible humeral nail system technique guide for. Surgical technique implant selection the trigen intertan nail preoperative template set 71674200 may be used to assist with preoperative implant selection. Given the extensive range of motion of the shoulder and. The purpose of this paper was to assess the clinical outcomes of proximal epiphyseal and diaphyseal humeral fractures treated with an antegrade humeral nail implanted after an interval rotator split.
This brochure is presented to demonstrate the surgical technique utilized by ralph b. Examples of specific indications according to ao classification include type afractures, dislo. Demonstration of performing proximal humeral fracture fixation with nailing using multi directional locking proximal humerus nail. Distal humeral plating of an intramedullary nail periprosthetic fracture using a missanail technique. In both surgical approaches, the special hole geometry of the nail ensures an optimal position of the locking holes. This brochure presents a surgical technique available for use with the biomet, inc. Trigen humeral nail proximal and long trigen hindfoot nail. Download download trigen humeral nail surgical technique pdf writer read online read online trigen humeral nail surgical technique pdf writer official fulltext paper pdf. A softtissue sparing technique for humeral shaft fixation with the use of a humeral intramedullary nail is demonstrated. Besides, the simpler upper third fractures can also be treated as the proximal end of the nail provides three horizontal and an oblique locking positions. The trigen hfn features an oblique locking configuration that allows surgeons to maximize thread purchase by locking into better bone. Pdf distal humeral plating of an intramedullary nail. Apr 21, 2017 humeral shaft fractures 2 surgical techniques.
The surgical technique is straightforward and is familiar to most pediatric orthopedists due to its widespread use in the treatment of other fractures in children 18, 2127. This device shows promise for applications involving the reconstruction of the humeral shaft and head with minimal soft tissue stripping and for providing a locked, fixed. T2 proximal humeral nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus. Add locking screw insert the locking screw caps with the 3. Twentyfour proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. Solid humeral nail uhn and proximal humeral nail phn. If a good ap image of the humeral head is viewed,the forearm can be locked at approximately 30o of external rotation. May 29, 2009 distal humeral plating of an intramedullary nail periprosthetic fracture using a missanail technique. Multiloc humeral nails provide a comprehensive system for the treatment of humeral fractures. Intramedullary nail versus dynamic compression plate. Retrograde single elastic intramedullary nail in closed. Proximal humerus fractures 2 part surgical neck fracture age bone quality demands of patient head viability hertel tuberosities most important no consensus on which fractures should be operated on proximal humerus fractures. The etched line on the nail will provide a reference for the. Biomet, as the manufacturer of this device, does not practice medicine and.
With a fixednail, fractures at the supracondylar area have occurred as result of the eccentric insertion of the nail, the narrow humeral canal and the stiffness of the nail. Uniflex humeral nail surgical technique zimmer biomet. 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. Metaanalysis of locking plate versus intramedullary nail. Although based on the wellknown t2 platform, the t2 proximal humeral nail design incorporates a number of unique features. In a 3 or 4part fracture, it is possible to fix the humeral head fragment with the intramedullary nail. In the correct clinical setting, humeral nailing provides an expeditious form of. With multiplanar screws that are threaded into the nail and designed to inhibit proximal screw backout, and effective, simple instrumentation designed to help protect soft tissues, the trigen humeral nail system offers. Furthermore, the development of the t2 humeral nailing system offers the competitive advantages of. The titanium flexible humeral nail system technique guide. Contour both nails into a bow shape with the nail tip pointing to the concave side of the bowed nail. Pdf intramedullary nailing of humeral shaft fractures. The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion.
Affixus natural nail proximal humeral system surgical. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time and decreasing blood loss. The technique described here is an anconeusmusclepreserving approach with bicolumnar visualization through medial and lateral windows that. In the correct clinical setting, humeral nailing is an expeditious form of fixation that. The t2 proximal humeral nail is intended to be used for various types of proximal andor diaphyseal fractures of the humerus. Surgical stabilization of humeral shaft fractures in children, when indicated, can be safely performed using titanium elastic nails. With a fixed nail, fractures at the supracondylar area have occurred as result of the eccentric insertion of the nail, the narrow humeral canal and the stiffness of the nail. Leaving the original prosthesis in place and using a missanail technique with medial and lateral plates around the prosthesis is a good method to secure the fracture with the minimum perioperative trauma to the patient and can. Surgical treatment of traumatic pediatric humeral diaphyseal. Interlocking intramedullary nailing for nonunion of the. Telegraph antegrade nailing in the treatment of humeral. This case demonstrates a softtissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. The t2 proximal humeral nail is intended for single use only. If using the sureshot distal targeting system, be sure to read and understand the trigen sureshot distal targeting system user manual ref 71181540.
Trigen humeral intramedullary nail the trigen humeral intramedullary nail brings the simplified instrumentation of the trigen nail system to the hindfoot. Nail size, screw length and femoral neck angle may be determined. Jun 30, 2009 the goal of this study was to evaluate fracture healing and alignment as well as functional outcome and complication risks after internal fixation with the intramedullary proximal humeral nail phn. Short 150 mm and long 185320 mm, in 15 mm increments. The main objective of this procedure is to anatomically reduce the tuberosities. This device shows promise for applications involving the reconstruction of the humeral shaft and head with minimal soft tissue stripping and for providing a locked, fixedangle construct for. Distal humeral fracture fixation with an extensor mechanism. May 29, 2009 distal humeral fractures associated with previous prosthetic nail present a challenge to the surgeon to obtain satisfactory results.
The humeral nail system can be used with or without the sureshot distal targeting system. 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. Over the years, humeral nailing has been considered as a homogenous procedure, regardless of the type of nail or the surgical technique used. Treatment of proximal humeral nonunion is one of the most difficult problems in shoulder surgery. One implant, two approaches stryker trauma has created a new generation locking nail system, bringing together all the capabilities and. Surgical treatment of complex proximal humeral fractures with. We treated six proximal epiphyseal fractures and seven bifocal. 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. Humeral shaft fractures, flexible nails, closed reduction and internal fixation 1.
The compliance of the nail construct was adjusted by overdrilling the near cortex reliable fracture union since the surgeon can. Nails with a proximal bend are best suited for simple twopart fractures of the proximal humerus involving the surgical neck of the humerus and proximal third humeral fractures without. Russelltaylor deltatibial interlocking nail technique 598 kb recon interlocking. Diaphyseal humeral fractures and intramedullary nailing.
Note as template magnification levels are set at 117%, all measurements are estimates of true size. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. In the correct clinical setting, humeral nailing provides an expeditious form of fixation that restores length, alignment, and rotation of the fracture humeral diaphysis. Ncb proximal humerus plating system surgical technique 1919. We searched pubmed, embase, and the cochrane databases for studies comparing locking plate and intramedullary nail treatment of displaced two, three, or fourpart proximal humeral fractures. Ncb proximal humerus plating system surgical technique. The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion synthes on. Moreover, in proximal humeral nonunions, 2 proximal interlocking screws are available even for a humeral head with cavitation. Various surgical procedures have been reported for their treatment.
The fracture can be rotated under flouroscopy until the fractures are restored to their anatomical positioning. Trigen meta nail tibia trigen meta nail femur trigen knee nail retrograde femoral technique 3. 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. Mar 14, 2017 open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. The options for the commonly used surgical treatment of humeral shaft fractures include intramedullary nailing imn and dynamic compression plate dcp, which offer good clinical outcomes. Trigen humeral intramedullary nail bmt medical devices. Surgical technique the procedure, performed under tourniquet control, is done with the patient in the supine position on a radiolucent operfig. The incision approach that is recommended and most often used for antegrade humeral nailing is the lateral deltoid splitting.
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