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. Manca, md short proximal humeral nail long proximal humeral nail removal of the handle and closure diaphyseal humeral nail. Centronail humeral instruments box, complete 1789911. They concluded that single elastic intramedullary nail fixation for the treatment of humeral shaft fractures in pediatric.
The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion. The titanium flexible humeral nail system technique guide. Proximal locking should be conducted using the standard image intensification free hand technique. Its flexiblity permits antegrade insertion close to the greater tubercle but away from the joint surface. Features and benefits proximal locking locking screws.
A locking nail of the newest generation is the socalled flex nail synthes company. Precice unyte humeral nail is an adjustable, stateoftheart device that utilizes a remote control to noninvasively compress and distract the humerus to ensure consolidation of open or closed fractures, nonunions or malunions. Short 150 mm and long 185320 mm, in 15 mm increments. The trigen humeral nail provides new possibilities for the treatment of proximal humeral fractures and humeral shaft fractures. This brochure is presented to demonstrate the surgical technique.
In an effort to avoid the rotator cuff footprint during humeral nail insertion, knierim et al 14 reported the neviaser portal approach to antegrade humeral nailing in. Pdf internal fixation of proximal humeral fractures with. One implant, two approaches stryker trauma has created a new generation locking nail system, bringing together all the capabilities and. Insert the nail until the nail tip protrudes only slightly into the humeral head.
Verify the position of the nail with the image intensifier. Distal humeral periprosthetic fractures below intramedullary nail devices are complex and challenging to treat, in particular due to the osteopenicporotic nature of bone found in these patients. During the 2011 meet the experts session, paulo barbosa from the intramedullary nailing group and stefaan nijs from the upper extremity group discuss the benefits of using the multiloc nail in proximal humeral fracture fixation in high and low energy trauma. Diaphyseal fractures of the humeral shaft proximal humeral fractures with diaphyseal extension impending pathologic fractures relative ontraindications the following conditions may present an.
Versanail humeral universal nailing system nail 10 figure 9 figure 10 image intensification can be used to place a kwire through the humeral head in line with the intramedullary axis of the humerus figure 9. Not only can the nail or rush rod or kuntscher nail easily lead to damage and stiffness of the shoulder joint because of interference with the rotator cuff, but they also fail to provide sufficient stability. 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. Pdf flexible intramedullary nailing for treatment of. 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. Talons perform best when deployed into the cortical bone of the humeral shaft. Diaphyseal humeral fractures and intramedullary nailing.
With the patient under general anesthesia, a standard longitudinal skin incision. Jul 29, 2015 the best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. The presentation pays particular attention to the screwinscrew technique and. Rotator cuffsparing approach for antegrade humeral.
Intramedullary nailing of humeral head and humeral shaft fractures figures 1a to 1c. This metaanalysis compared the clinical outcomes of locking plate with intramedullary nail in the treatment of displaced proximal humeral fractures. The mean age was 10 years old at the time of surgery, with a range from 7 to 12 years. Proximal humeral nail diaphyseal humeral nail 79 mm 5. Proximal humeral fractures and intramedullary nailing. The trapezoidal nail profile provides enhanced rotational stability in the humerus and adds a smaller dimension to the nail profile in the ap. Trigen humeral nail surgical technique pdf writer telegraph. Uniflex humeral nail surgical technique zimmer biomet. The trigen humeral nail system is designed specifically for the treatment of proximal humeral fractures and humeral shaft fractures, and is indicated for the repair of nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. 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 solid nail design of the short nail 150mm should not require additional reaming for nail insertion. The trigen humeral intramedullary nail brings the simplified instrumentation of the trigen nail system to the hindfoot. The trigen humeral nail with its versatile screw configuration was shown in a cadaver study to be one of the safest humeral nails for avoiding axillary nerve damage3 the trigen humeral nail system with sureshot technology is designed to distal lock the nail first, using the electromagnetic wand and perfect circles method for fewer. Centronail humeral nailing system humeral nailing system one design for left or right humerus proximal bend 15 proximal humeral nail. The agency received the clearance request on january 26, 2018 and notified the company on february 22, 2018. All implants of the t2 proximal humeral system are made from type ii anodized titanium alloy ti6al4v to maximize mechanical strength and biocompatibility. Trigen humeral nail features include trapezoidal nail profile, four multiplanar proximal screws and multiple lengths bent and straight. Humeral nail system cleared in under 30 days orthopedics. Modern proximal humeral nail designs and techniques assist the surgeon in. The fda just cleared orthopedic designs north america, inc. Nonunion of humeral shaft fractures following flexible. Intramedullary nailing group and stefaan nijs from the upper extremity group discuss the benefits of using the multiloc nail in proximal humeral fracture fixation in high and low energy trauma. Metaanalysis of locking plate versus intramedullary nail for. Summary application of humeral nail in the treatment of humeral shaft fractures is a.
It can be used universally for either the left or right humerus. The trigen hfn features an oblique locking configuration that allows surgeons to maximize thread purchase by locking into better bone. The titanium flexible humeral nail system technique guide for. Two nails of the same diameter were introduced into the humeral medullary canal and advanced beyond the fracture site, up to the proximal metaphysis of the humerus. Pdf internal fixation of proximal humeral fractures with a. Flexible intramedullary nailing for treatment of proximal. The aim of the study was to stress out the complexity of appropriate operative treatment of humeral shaft fractures using intramedullary fixation, as well as the importance of proper reduction and stable fixation. Metaanalysis of locking plate versus intramedullary nail.
Examples of specific indications according to ao classification include type afractures, dislo. The t2 proximal humeral nail is intended for single use only. T2 proximal humeral nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus. To complement the t2 nailing system, stryker osteosynthesis has created a humeral implant. The inflatable intramedullary nail for humeral shaft. The multiloc humeral nail system has not been evaluated for safety and compatibility in the mr environment. Entry portal for a straight nail is 5 mm posterior to the. The nail insertion process must also align humeral proximal fractures. This allows the insertion of a lateromedial locking bolt into the humeral head distally to the rotator cuff. Instruments and implants approved by the ao foundation. Pdf intramedullary nailing of the proximal humerus. Modern proximal humeral nail designs and techniques assist the surgeon in adhering. Bone nail endcap, sterile a small, sterile, rounded plug, cover or threaded screw designed to seal the proximal end of an orthopaedic nail implanted to treat a damaged bone e. 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.
A new proximal humeral nail with multiple screw placement option. Fixation is often difficult to satisfactorily achieve around the intramedullary device, whilst minimising soft tissue disruption. Trigen humeral intramedullary nail bmt medical devices. Intramedullary nail for proximal humerus fractures. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time and decreasing blood loss. The risk of shaft disruption during retrograde insertion of the nail is greatly reduced. The talon distalfix humeral nail system is indicated to aid in the alignment and stabilization of humeral fractures, including. Surgical technique this publication is not intended for distribution in the usa. Multiloc humeral nails surgical technique depuy synthes 1. There are some key considerations to this approach.
Flexible intramedullary nailing for treatment of proximal humeral and humeral shaft fractures in children. New technology may lead to unexpected complica tions. Solid humeral nail uhn and proximal humeral nail phn surgical technique. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. The agency received the clearance request on january 26, 2018 and notified the company on. The russelltaylor humeral nail smith and nephew, richards was used in all patients. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. 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.
Humeral nonunion is defined as a fracture with no evidence of healing 24 weeks after injury. We have been using a novel nail to treat pathological humeral fractures. Using a humeral intramedullary fixation nail hifn for humeral fractures is one of effective mis minimally invasive surgery methods, and this kind of surgery can usually provide the patient with an early recovery 1,2. Descriptions of such cases in the current literature are. There were 19 males and 4 females, 15 with right arm fractures and 8 with left arm fractures. One significant limitation of this technique is chronic postoperative shoulder pain, which is likely related to the standard approach that involves splitting the rotator cuff to gain access to the nail starting point. The humeral nail system can be used with or without the sureshot distal targeting system. Development of humeral intramedullary fixation nail hifn based on korean cadaveric tests 1changsoo chon, 2cheolwoong ko and 3jongkeon oh 1biomedical engineering institute, solco biomedical co. This nail can be inserted in both ante and retrograde technique. The humeral nail of medimetal was developed to treat variously located diaphyseal fractures. The solid humeral nail uhn can be inserted into the humeral shaft in both antegrade or retrograde directions and can be used universally for the left and the right humerus. 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. Intramedullary splintage, either with a nail or with rush rods, has virtually no place in the treatment of acute humeral fractures.
Although based on the wellknown t2 platform, the t2 proximal humeral nail design incorporates a number of unique features. Trigen humeral nailing includes a 16cm proximal straight nail, a 16cm proximal bent nail, and a full line of long bent nails. Explosion of fixionw humeral nail during cremation core. Difficulties in free hand locking proximally at the nail tip occurred in 5. T2 proximal humeral nailing system contributing surgeons.
Most of the hifns shown in korea are mainly foreignmade ones. In all 91 followup patients, bone healing occurred, but 5 fractures 5. The t2 proximal humeral nail is intended to be used for various types of proximal andor diaphyseal fractures of the humerus. The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion synthes on. This case demonstrates a softtissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. On the other hand, the smaller diameter of the inflatable humeral nail offers easier insertion into the humeral canal.
The thickness of the nail was chosen to be approximately one third of the diameter of the humeral marrow cavity. Several studies 6, 1117 have focused on locking plate and intramedullary nail treatment of displaced two, three, and fourpart proximal humeral fractures. Internal fixation of proximal humeral fractures with a polarus humeral nail article pdf available in journal of orthopaedics and traumatology 93. 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. Antegrade intramedullary nails are an established, effective method of fixation for humeral shaft fractures. The expert humeral nail can be inserted into the humeral shaft in both antegrade and retrograde directions. The first is to use the joysticks to extend and adduct the hu. Solid humeral nail uhn and proximal humeral nail phn. The talon distalfix humeral nail system has not been evaluated for safety and compatibility in the mr environment.
A second nail driving guide wire of the same length is used to measure the length of the medullary canal figure 7. The special hole geometry of the nail ensures optimal positioning of the locking bolts in both approaches. For antegrade nail insertion, the patient is placed in a semisited position on a radiolucent table. Expert humeral nail and expert proximal humeral 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. 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. Retrograde single elastic intramedullary nail in closed. 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. Multiloc humeral nails provide a comprehensive system for the treatment of humeral. Over 250,000 doctors use vumedi to improve patient care and grow their practice. Extended neviaser portal approach to antegrade humeral nailing. The compliance of the nail construct was adjusted by overdrilling the near cortex reliable fracture union since the surgeon can.1473 684 72 1518 320 22 626 899 687 777 1292 1002 829 1513 640 748 518 924 110 145 782 728 397 498 1099 28 819 24 1371 8 81 874 698 259 137