Humeral shaft fracture stabilization with elastic nails nathan w. Fracture classification this surgical technique includes the surgical treatment of the following types of fractures. Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and. Browse the amazon editors picks for the best books of 2019, featuring our. Nails and nail drill guide are keyed to ensure proper orientation of the nail on the drill guide the following technique is for informational and educational purposes only. Antegrade humeral nailing through the rotator cuff. Other complications included shoulder stiffness in four cases. Flexible intramedullary nailing for treatment of proximal. T2 proximal humeral nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus. Our initial indication for using a nail for ph fractures was displaced fractures of the surgical neck in elderly patients. Trigen humeral intramedullary nail bmt medical devices. Some patients, however, require internal fixation either because of an inability to maintain an adequate reduction, significant soft tissue injury, or concomitant fractures. Potential compression must be taken into account when determining the nail length and a shorter nail may be chosen.
The aequalis humeral nail can be used either percutaneously or in open surgery. Trigen metanail tibial nail specifications distal end of nail all knee and distal tibial top view of nail nondriving end of nail ap view ml view set does not include all sizes. The order of insertion of proximal and distal screws relies on fracture types and surgeons preference. However, nail fixation for ph fracture is not a panacea, and. The trigen hfn features an oblique locking configuration that allows surgeons to maximize thread purchase by locking into better bone.
Solid humeral nail uhn and proximal humeral nail phn. The multiloc humeral nail long includes easily identi. Music for body and spirit meditation music recommended for you. Discover book depositorys huge selection of surgical techniques books online. Proximal humerus fractures includes everything the orthopedic surgeon needs to know about the clinical management of these common shoulder injuries.
Although nonoperative treatment techniques are addressed and can be used in less severe circumstances, this book focuses mainly on the current operative treatment techniques for proximal humerus and tuberosity fractures, malunions and nonunions. 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. Manca, md short proximal humeral nail long proximal humeral nail removal of the handle and closure diaphyseal humeral nail antegrade. The nail tip should be positioned at least 25 mm away from the cranial boundary of the olecranon fossa. Interlocking contoured intramedullary nail fixation for selected this information is current as of december 23, 2009. Fractures of the humeral shaft represent % of all fractures seen in accident and emergency departments, with approximately 20 % of all humeral fractures, and it is the third most common fracture in individuals older than 65 years after hip fractures and distal radial fractures. Most humeral shaft fractures are undisplaced or minimally displaced and can be managed non. Proximal locking is done using a free hand technique and the tip of the nail should be below the level of the surgical humeral neck,26. Nail surgery is a precise technique that requires careful administration and attention to details. Eric gordon definition humeral shaft fractures comprise approximately 2.
Specifically, the precice nail has accurate control over the lengthening process. Increase brain power, focus music, reduce anxiety, binaural and isochronic beats duration. The humeral nail system can be used with or without the sureshot distal targeting system. Modern proximal humeral nail designs and techniques assist the surgeon in adhering to these principles and. Surgical management of fracture shaft of humerus in adults. Features and benefits proximal locking locking screws indications equipment required. Edition of this highly regarded text continues to provide the latest therapeutic and surgical information on nail disease.
Many complications were related to incorrect surgical technique and. This case demonstrates a softtissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. Check the reduction and read off the nail length from the image of the ruler. Solid humeral nail uhn and proximal humeral nail phn surgical technique. The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion synthes on. Measure the length of the unfractured humerus from its head to the olecranon fossa and deduct 56 cm from the measured distance. The uniflex humeral nail system can be used to manage fractures from the surgical neck of the humerus to a point approximately 6cm above the end of the medullary canal. Modern proximal humeral nail designs and techniques assist the surgeon in adhering to these principles and have demonstrated promising outcomes. Multiplanar distal locking reduces implant toggling in proximal humeral nailing.
One patient had a varus malalignment of 15 degrees. This brochure presents a surgical technique available for use with the biomet, inc. Pdf intramedullary nailing of the proximal humerus. In the dynamic locking mode, the pull of muscles spanning the fracture may be used for secondary dynamization. These views are not to scale and should be used as a pictorial representation only. Many complications of humeral locked nailing can be prevented by improving the implant design or surgical techniques. Different types of external fixators have been used for hu. Fractures of the humeral shaft are relatively common injuries and the majority achieve union uneventfully. Proper patient preparation starts with a patient history to identify. This study describes a new entry portal through the rotator interval that minimizes iatrogenic damage to the rotator cuff at its insertion. Surgical technique uhn phn humeral nailing system depuy synthes 7 2. They concluded that single elastic intramedullary nail fixation for the treatment of humeral shaft fractures in pediatric patients is an adequate technique with. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. Determine nail length the approximate nail length can be determined pre operatively.
Intramedullary nail imn became a valid surgical option for humeral shaft. This approach offers a solution for the disappointing postoperative shoulder function and pain scores associated with conventional. Everyday low prices and free delivery on eligible orders. Inserted in a reduced diameter and expanded within the medullary canal. The locking screw in the compression slot can move by up to 8 mm distally. Surgical technique uhnphn humeral nailing system depuy synthes 7 2. Flexible intramedullary nailing for treatment of proximal humeral and humeral shaft fractures in children. There are now some nail surgery books in the market that help to find surgical techniques. Low tolerance to malunion and recent advances in internal fixation techniques have increased surgical indications. Copublished with the arthroscopy association of north america, the shoulder.
The titanium flexible humeral nail system technique guide. Versanail humeral proximal nailing system sales sheet. Aana advanced arthroscopic surgical techniques is authored by premier arthroscopic surgeons drs. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time and decreasing blood loss.
Management of nonunion of humeral fractures with the. Humeral shaft fracture stabilization with elastic nails. The modular implant system, consisting of a short and long nail with multiple locking options, covers a wide. The t2 humeral nailing system is systems to offer an option for either an antegrade or a retrograde approach to repair fractures of the humerus. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Distal locking screws for the 18cm or longer humeral nails should be targeted using a freehand technique. Despite the many surgical techniques described for the management of nonunions, including plate fixation, intramedullary nailing or external fixation, some cases remain. A guide to assessment and treatment 2015 by filippo castoldi, davide blonna, marco assom isbn. The upper 7cm must be reamed to llmm to accommodate the larger diameter proximal end of the nail. By american shoulder and elbow surgeons 2010 featuring joaquin sanchezsotelo november 2010. In both surgical approaches, the special hole geometry of the nail ensures. Aana advanced arthroscopic surgical techniques is a comprehensive techniquebased book that presents the latest.
The affixus natural nail humeral system is a long bone nailing system that is built on the natural nail and affixus intramedullary platforms. The distal locking hole configuration allows for either static or dynamic locking modes. This system offers a complete portfolio of implants and instruments, which treats a wide range of humeral fractures using simple and efficient instrumentation. Similar outcomes for nail versus plate fixation of three. Besides the t2 femoral nail with a 3m radius of curvature, stryker offers also a 1. Nearly all pediatric humeral shaft fractures can be successfully treated with closed methods. Humeral lengthening with the precice magnetic lengthening. Surgical technique surgical devices and advanced wound. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological.
The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion. Surgical technique the procedure, performed under tourniquet control, is done. It is the responsibility of treating physicians to determine and utilize the appropriate products and techniques. Surgeons can maintain fracture reduction with all the associated benefits of intramedullary nailing. The trigen humeral intramedullary nail brings the simplified instrumentation of the trigen nail system to the hindfoot.
This book is the first of its kind in english to explore mistakes in surgery. To request a price quote andor surgical evaluation of products, please add all products of interest to your cart by selecting the respective product checkboxes in the quote 1 andor surgical evaluation 2 column of the products view. The mean age was 10 years old at the time of surgery, with a range from 7 to 12 years. Interlocking contoured intramedullary nail fixation for. Surgeons may need to make modifications as appropriate in their own surgical technique with these devices depending on individual patient requirements. No elbow impairment, malunion or post nailing radial nerve palsy was observed in any patient.
Common 5mm cortical screws simplify the surgical procedure and promote a minimally invasive approach. Once the nail tip is seated in the humeral head, lock proximally using the radiolucent drive see page 23, steps 7 10 or the freehand. Precicenail introduction humeral deformity and shortening have both functional and esthetic implications leading to surgical intervention 22. The bend of the nail allows insertion at the standard insertion. Multiloc humeral nailing system surgical technique depuy synthes 3. Unique proximal screw configuration enhances fragment fixation 4. One implant, two approaches stryker osteosynthesis has created a locking nail system, bringing together all the capabilities and benefits of separate antegrade and retrograde nailing. The similar outcomes for nail versus plate fixation of threepart proximal humeral fractures after 1 year for our patients suggest that all three techniques may be useful for internal fixation of threepart proximal humeral fractures. With the multiloc humeral nailing system, synthes opens up new opportunities for the treatment of humeral fractures. Retrograde single elastic intramedullary nail in closed.