Biomet, as the manufacturer of this device, does not practice medicine and. Distal humeral plating of an intramedullary nail periprosthetic fracture using a missanail technique. Ncb proximal humerus plating system surgical technique 1919. The t2 proximal humeral nail is intended to be used for various types of proximal andor diaphyseal fractures of the humerus. 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. Over the years, humeral nailing has been considered as a homogenous procedure, regardless of the type of nail or the surgical technique used. Although based on the wellknown t2 platform, the t2 proximal humeral nail design incorporates a number of unique features. The main objective of this procedure is to anatomically reduce the tuberosities.
Interlocking intramedullary nailing for nonunion of the. Trigen meta nail tibia trigen meta nail femur trigen knee nail retrograde femoral technique 3. The uniflex humeral nail system was developed in conjunction with ralph b. Nail size, screw length and femoral neck angle may be determined. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. The compliance of the nail construct was adjusted by overdrilling the near cortex reliable fracture union since the surgeon can. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time and decreasing blood loss. 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. 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. Leaving the original prosthesis in place and using a missa nail 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 achieve a good functional outcome.
If using the sureshot distal targeting system, be sure to read and understand the trigen sureshot distal targeting system user manual ref 71181540. 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. Mar 14, 2017 open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. Distal humeral fractures associated with previous prosthetic nail present a challenge to the surgeon to obtain satisfactory results. Affixus natural nail proximal humeral system surgical. Short 150 mm and long 185320 mm, in 15 mm increments. Uniflex humeral nail surgical technique zimmer biomet. The trigen humeral intramedullary nail brings the simplified instrumentation of the trigen nail system to the hindfoot. May 29, 2009 distal humeral plating of an intramedullary nail periprosthetic fracture using a missanail technique. Trigen humeral intramedullary nail bmt medical devices. Mar 16, 2009 twentyfour proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p. Download download trigen humeral nail surgical technique pdf writer read online read online trigen humeral nail surgical technique pdf writer official fulltext paper pdf.
In the correct clinical setting, humeral nailing provides an expeditious form of fixation that restores length, alignment, and rotation of the fracture humeral diaphysis. Add locking screw insert the locking screw caps with the 3. Trigen humeral nail proximal and long trigen hindfoot nail. Surgical treatment of complex proximal humeral fractures. Surgical treatment of complex proximal humeral fractures with. Note as template magnification levels are set at 117%, all measurements are estimates of true size. Twentyfour proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail.
The fracture can be rotated under flouroscopy until the fractures are restored to their anatomical positioning. The humeral nail system can be used with or without the sureshot distal targeting system. 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. Apr 21, 2017 humeral shaft fractures 2 surgical techniques. Make sure there is no blood in the screwdriver cannulation since this may push the kwire forward. Russelltaylor deltatibial interlocking nail technique 598 kb recon interlocking. 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. Humeral shaft fractures, flexible nails, closed reduction and internal fixation 1. If a good ap image of the humeral head is viewed,the forearm can be locked at approximately 30o of external rotation. Ncb proximal humerus plating system surgical technique 2121 7. 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. Retrograde single elastic intramedullary nail in closed. Surgical stabilization of humeral shaft fractures in children, when indicated, can be safely performed using titanium elastic nails.
The fda just cleared orthopedic designs north america, inc. Metaanalysis of locking plate versus intramedullary nail. We treated six proximal epiphyseal fractures and seven bifocal. The etched line on the nail will provide a reference for the. Given the extensive range of motion of the shoulder and. The titanium flexible humeral nail system technique guide. 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. We propose a standardized and reproducible technique that we apply to all complex displaced 3 and 4part fractures of patients under 50 years. Proximal humeral fractures and intramedullary nailing. The nail insertion process must also align humeral proximal fractures. The mean age was 10 years old at the time of surgery, with a range from 7 to 12 years. Demonstration of performing proximal humeral fracture fixation with nailing using multi directional locking proximal humerus nail. The trigen hfn features an oblique locking configuration that allows surgeons to maximize thread purchase by locking into better bone. This brochure is presented to demonstrate the surgical technique utilized by ralph b.
The trigen humeral nailing system product offering includes a 16cm proximal straight nail, a 16cm proximal bent nail, and a full line of long bent nails. 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 nail surgical technique pdf writer telegraph. The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion. Trigen humeral intramedullary nail the trigen humeral intramedullary nail brings the simplified instrumentation of the trigen nail system to the hindfoot.
In the correct clinical setting, humeral nailing provides an expeditious form of. In the correct clinical setting, humeral nailing is an expeditious form of fixation that. The technique is easy to perform and substantially minimizes surgical exposure, decreasing surgical time and blood loss. One implant, two approaches stryker trauma has created a new generation locking nail system, bringing together all the capabilities and. 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 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. With cavitation of the humeral head fragment as a result of severe bone loss. Multiloc humeral nails provide a comprehensive system for the treatment of humeral fractures. Surgical technique the procedure, performed under tourniquet control, is done with the patient in the supine position on a radiolucent operfig. Humeral nail system cleared in under 30 days orthopedics. 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.
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. 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. 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. Solid humeral nail uhn and proximal humeral nail phn. The technique described here is an anconeusmusclepreserving approach with bicolumnar visualization through medial and lateral windows that. 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. Examples of specific indications according to ao classification include type afractures, dislo. Surgical stabilization of humeral shaft fractures in children, when indicated, can.
The incision approach that is recommended and most often used for antegrade humeral nailing is the lateral deltoid splitting. Intramedullary nail versus dynamic compression plate. Telegraph antegrade nailing in the treatment of humeral. At present, both of these surgical approaches are used to treat humeral shaft fractures. T2 proximal humeral nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus. Distal humeral fracture fixation with an extensor mechanism. Surgical management of fracture shaft of humerus in adults.
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. Treatment of proximal humeral nonunion is one of the most difficult problems in shoulder surgery. Chief of surgical services, medical director of murnau trauma center. 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. Jun 29, 2017 demonstration of performing proximal humeral fracture fixation with nailing using multi directional locking proximal humerus nail. The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion synthes on. Check the reduction and read off the nail length from the image of the ruler. Open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. A softtissue sparing technique for humeral shaft fixation with the use of a humeral intramedullary nail is demonstrated.
Surgical treatment of traumatic pediatric humeral diaphyseal. Diaphyseal humeral fractures and intramedullary nailing. Furthermore, the development of the t2 humeral nailing system offers the competitive advantages of. The titanium flexible humeral nail system technique guide for. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. Moreover, in proximal humeral nonunions, 2 proximal interlocking screws are available even for a humeral head with cavitation. In a 3 or 4part fracture, it is possible to fix the humeral head fragment with the intramedullary nail.
Distal humeral fracture fixation with an extensor mechanismon approach jason m. The humeral nail of medimetal was developed to treat variously located diaphyseal fractures. There were 19 males and 4 females, 15 with right arm fractures and 8 with left arm fractures. Proximal humeral nail diaphyseal humeral nail 79 mm 5. 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. Contour both nails into a bow shape with the nail tip pointing to the concave side of the bowed nail. Introduction incidence of fracture of the humerus shaft is between 3% and 5% of all fractures1,2. Proximal humerus fractures foundation for orthopaedic. Techniquenail insertion for pediatric femur contouring the nail additionally available item contouring may be done by hand or with the tabletop platebending press 329. Introduction open treatment of extraarticular and intraarticular distal humeral the fractures can be effectively accom. Interlocking contoured intramedullary nail fixation for. 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. Pdf intramedullary nailing of humeral shaft fractures.
The aequalis humeral nail can be used either percutaneously or in open surgery. May 29, 2009 distal humeral fractures associated with previous prosthetic nail present a challenge to the surgeon to obtain satisfactory results. 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. Surgical technique implant selection the trigen intertan nail preoperative template set 71674200 may be used to assist with preoperative implant selection. 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 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.
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