The trigen metanail retrograde femoral nail is indicated for fractures of the femur including stable and unstable distal metaphyseal fractures, diaphyseal fractures, intraarticular fractures, periprosthetic fractures, nonunions, malunions and for the prophylactic nailing of impending pathological fractures. Precicenail introduction humeral deformity and shortening have both functional and esthetic implications leading to surgical intervention 22. Ten titanium elasticnail standard surgical technique 9 insert first nail insert the nail into the medullary cavity with the nail tip at right angles to the bone shaft 1. Furthermore, the development of the t2 humeral nailing system offers the competitive advantages of. Chief of surgical services, medical director of murnau trauma center. Review article management of humeral shaft fractures. Open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. 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 trigen metanail tibial nail system is designed specifically to repair fractures of the proximal and distal thirds of the tibia, including the shaft, stable and unstable fractures, nonunions, malunions, and for the prophylactic nailing of impending pathological fractures.
Trigen humeral nail features include trapezoidal nail profile, four multiplanar proximal screws and multiple lengths bent and straight. Interlocking intramedullary nailing for nonunion of the. The proximal humerus can also be prepared by using the humeral broach. Telegraph antegrade nailing in the treatment of humeral.
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 titanium flexible humeral nail system technique guide for antegrade or retrograde insertion synthes on. The main objective of this procedure is to anatomically reduce the tuberosities. The titanium flexible humeral nail system technique guide. 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. The quality of the fixation offered to the fracture site by bionails depends mainly on the features and design of each nail, as well as on the surgical technique and the fracture configuration. Use the humeral nail guide bolt to attach the nail drill guide to the broach figure 6. The titanium flexible humeral nail system technique guide for antegrade or retrograde insertion. Other medical or surgical conditions which would preclude the potential benefit of surgery. Expert humeral nailing system surgical technique depuy synthes 43.
Note as template magnification levels are set at 117%, all measurements are estimates of true size. 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 compliance of the nail construct was adjusted by overdrilling the near cortex reliable fracture union since the surgeon can. The patient was placed in lateral decubitus position under general anesthesia ga. Only trained operators are allowed to use the trigen sureshot distal targeting system.
The broaching method utilizes the noncylindrical shape of the proximal body of the nail to help rotationally stabilize the nail during insertion of the locking screws. Distal humeral fractures associated with previous prosthetic nail present a challenge to the surgeon to obtain satisfactory results. Techniquenail insertion for pediatric femur inserting the nail locate and maintain the entry hole with a fingertip while withdrawing the drill bit and introducing the nail. Surgical procedure or preparation trauma interface setup after the sterile areas have been established, place the trauma interface 71692802 in the. Longitudinal cut inferior to the anterolateral corner of the acromion. The surgeon may have to consider other techniques for certain fractures such as. Surgical treatment of complex proximal humeral fractures with a technique of nail and osteosuture. Surgical technique implant selection the trigen intertan nail preoperative template set 71674200 may be used to assist with preoperative implant selection. Specifically, the precice nail has accurate control over the lengthening process. The multiloc humeral nail long includes easily identi. For the full surgical procedure, please refer to the specific surgical technique for the trigen im nail system being implanted.
Multilevel corrective osteotomy was performed with drill and osteotome. Although based on the wellknown t2 platform, the t2 proximal humeral nail design incorporates a number of unique features. Treatment of proximal humeral fractures with im nails. Trigen humeral nail system offers an effective intramedullary nail for humeral fracture management. Interlocking intramedullary nailing for nonunion of the proximal humerus with the straight nail system. Operative technique t2 proximal humeral nailing system. Surgical technique orthopedic designs north america, inc. 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. This video demonstrates the technique for intramedullary nailing of a humeral shaft fracture. 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 website uses cookies to help you get the most out of your experience during your visit, and we can improve the content served to you by collecting statistical information. Rotator cuffsparing approach for antegrade humeral. Inclusion criteria were 1 acute humeral shaft fractures treated with t2proximal humeral nail phn and 2 a minimum followup of one year.
The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time and decreasing blood loss. In both surgical approaches, the special hole geometry of the nail ensures an optimal. 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. Multiloc humeral nailing system surgical technique depuy synthes 3 multiplanar distal locking multiplanar distal locking reduces implant toggling in proximal humeral nailing. Im nailing enders, rush standard locked nail proximal humeral nail arthroplasty usually reserved for displaced 4part fractures. 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. Our initial indication for using a nail for ph fractures was displaced fractures of the surgical neck in elderly patients. Solid humeral nail uhn and proximal humeral nail phn surgical technique.
If using the sureshot distal targeting system, be sure to read and understand the trigen sureshot distal targeting system user manual ref 71181540. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. Twentyfour proximal humeral fractures were treated by surgical internal fixation with a locked antegrade intramedullary nail. Intramedullary locking nail fixation of proximal humerus. Pdf intramedullary nailing of the proximal humerus. 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 mechanismon approach jason m. Place the carm opposite the surgeon, perpendicular to the longitudinal axis of the humeral shaft in the ap view. Short and long humeral nail medin proximal humeral nails. As a result, surgeons witnessed the appearance of a wide variety of. The patient shown in the video is a 30yearold man who sustained a gunshot wound to his right arm. Small diameter intramedullary implant that requires only a 10mm.
The aequalis humeral nail can be used either percutaneously or in open surgery. If using the sureshot distal targeting system, be sure to read and understand the trigen sureshot distal targeting system user manual. Pdf intramedullary nailing of humeral shaft fractures. Short humeral nails the short humeral nail enables osteosynthesis of armbone head.
A retrospective cohort of 48 patients treated for humeral diaphyseal fractures at the university hospital of parma between 2007 and 2011 was analysed. Modern proximal humeral nail designs and techniques assist the surgeon in. The titanium elastic nail system technique guide original instruments and implants of the association. 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 novel design of the aequalis im locking nail combines unique features that allow a less invasive surgical intervention, sustain the vascularization of the fracture fragments, angular stability of proximal fixation, and optimal screw orientation for fixation of the tuberosities. Surgeons may need to make modifications as appropriate in their own surgical technique with these devices depending on individual patient requirements. The humeral nail system can be used with or without the sureshot distal targeting system. Solid humeral nail uhn and proximal humeral nail phn. 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 features of the nail and the surgical technique also are. This brochure is presented to demonstrate the surgical technique utilized by ralph b. Check the reduction and read off the nail length from the image of the ruler. This article describes the use of the elastic nail for intramedullary fixation of humeral fractures and nonunions in 170 patients. Trigen humeral intramedullary nail bmt medical devices. Im lengthening nails can provide successful and safe humeral lengthening. Management of humeral shaft fractures abstract humeral shaft fractures account for approximately 3% of all fractures. Using humeral nail for surgical reconstruction of femur in adolescents with osteogenesis imperfecta. Nail size, screw length and femoral neck angle may be determined. Uniflex humeral nail surgical technique zimmer biomet. The trigen humeral intramedullary nail brings the simplified instrumentation of the trigen nail system to the hindfoot. More variants of locking allow good fixation of short fragments and optimal reposition of the fractures.
Proximal humerus fractures foundation for orthopaedic. 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. Despite many differences in design and intended surgical technique, humeral nails can be grouped generally. Antegrade intramedullary nails are an established, effective method of fixation for humeral shaft fractures.
Trigen humeral nail surgical technique pdf writer telegraph. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. Treatment of proximal humeral fractures with im nails 14th annual trauma 101. The trigen hfn features an oblique locking configuration that allows surgeons to maximize thread purchase by locking into better bone. Surgical stabilization of humeral shaft fractures in children, when indicated, can. Manca, md short proximal humeral nail long proximal humeral nail removal of the handle and closure. Surgical treatment of complex proximal humeral fractures. This case demonstrates a softtissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. The use of elastic nails for intramedullary fixation of. Humeral nailing was indicated given the comminuted nature of the diaphysis and to allow for minimal skin incisions. If necessary, check the position of the nail tip with the image in.
Senior trauma surgeon, murnau trauma center murnau. Biomet, as the manufacturer of this device, does not. Multiloc humeral nailing system surgical technique depuy synthes. Position the carm to allow visualization of the entire humerus in the ap and lateral planes.