Intramedullary nail for proximal humerus fractures. Nonunion of humeral shaft fractures following flexible. Uniflex humeral nail surgical technique zimmer biomet. Results of the t2 humeral nailing system with special focus. Surgical technique multiloc humeral nailing system 2 ao principles 4 indications 5 screw configuration 6 multiloc proximal humeral nail short 6 multiloc humeral nail long 8 clinical cases 10 preoperative planning patient positioning and approach 14 entry point 18 opening of the humerus 20 open medullary canal 20 reduce fracture and ream. Complications after interlocking intramedullary nailing of. 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. Distal locking screws for trigen proximal 16cm humeral nails 14.
Free full text availability of articles in html as well as pdf. Humeral shaft fracture is one of the most common fractures in adults, accounting for approximately 3% of all fracture types. Humeral nail designs have undergone significant innovation during the past 40 years and now can provide stable fixation in the humeral shaft distally as well as improved stability in the head and. 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.
An interlocking nail is basically an intramedullary pin secured in position by proximal and distal transfixing screws which engage the bone to the nail to provide axial bending and torsional stability. Humerus fracture, intramedullary nail, shoulder problems, plate fixation. Interlocking nails are a refinement of the original kuntscher nail. The outcome of interlocking nailing of humeral shaft fractures, a one. The trapezoidal nail profile provides enhanced rotational stability in the humerus and adds a smaller dimension to the nail profile in the ap. Four proximal locking holes strategically placed to enable locking of separate fragments of the lesser tuberosity, the greater tuberosity and the humeral head.
The original interlocking nail system innovative animal. We describe an approach through the rotator interval with tenodesis of the biceps tendon and resection of the intra. The proximal locking holes in the nail are threaded. The top countries of suppliers are india, india, and china, from which the percentage of humerus. Antegrade interlocking intramedullary nailing in humeral. With the patient under general anesthesia, a standard longitudinal skin incision. An expandable self locking nailing system no distal screws required. Box 5000, fin90014 university of oulu, finland 2004 oulu, finland abstract although nonoperative treatment is recognized as an effective treatment method for humeral shaft. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist duration. Flinkkila, tapio, intramedullary nailing of humeral shaft fractures division of orthopaedic and trauma surgery, department of surgery, university of oulu, p.
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. Displaced or unstable fractures require open reduction and internal fixation. Inserted in a reduced diameter and expanded within the medullary canal. 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. Insert the nail into the medullary cavity with the nail tip at right angles to the bone shaft 1. Insert the nail until the nail tip protrudes only slightly into the humeral head. 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. This allows the insertion of a lateromedial locking bolt into the humeral head distally to the rotator cuff.
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. Pdf in todays world the incidents of fracture of the shaft of humerus or as a whole trauma to the extremities, is on the rise. Diaphyseal fractures of the humeral shaft proximal humeral fractures with diaphyseal extension impending pathologic fractures relative ontraindications the following conditions may present an. A wide variety of humerus interlocking nail options are available to you, there are 61 suppliers who sells humerus interlocking nail on, mainly located in asia. Descriptions of such cases in the current literature are very rare. It can be used universally for either the left or right humerus. Retrograde single elastic intramedullary nail in closed. The trigen humeral nail provides new possibilities for the treatment of proximal humeral fractures and humeral shaft fractures.
Fourteen consecutive patients with pain and functional impairment due to proximal humeral nonunion were treated operatively by use of an interlocking intramedullary nail with the straight nail system between 1996 and 2003. After the exclusion of 1 patient who had a brachial plexus palsy at the time of the accident, patients were followed up retrospectively. T2 proximal humeral nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus. Most of the hifns shown in korea are mainly foreignmade ones.
Pdf fractures of the humeral shaft account for 3% of all the fractures. 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. If necessary, check the position of the nail tip with the image intensifier. Between 1997 and 2005, 99 acute fractures of the humeral shaft were treated operatively with the unreamed humeral nail uhn, synthes in. There are some key considerations to this approach. T2 proximal humeral nail the t2 proximal humeral nail is intended to be used for various types of proximal andor diaphyseal fractures of the humerus. Intramedullary nail versus plate fixation for humeral shaft. This system offers a complete portfolio of implants and instruments, which treats a wide range of humeral fractures using simple and efficient instrumentation. With multiplanar screws that are threaded into the nail to inhibit proximal screw backout, and effective, simple instrumentation that helps protect soft tissues, the trigen. With multiplanar screws that are threaded into the nail to inhibit proximal screw backout, and effective, simple instrumentation that helps protect soft tissues, the trigen system now offers an effective. Metaanalysis of locking plate versus intramedullary nail for. 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. Proximal humeral nail diaphyseal humeral nail 79 mm 5.
Internal fixation of proximal humerus fractures using the t2. Fixation is often difficult to satisfactorily achieve around the intramedullary device, whilst minimising soft tissue disruption. We present a clinical prospective study evaluating this implant for proximal. Verify the position of the nail with the image intensifier. 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. 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. Surgical management of proximal humerus fractures remains controversial and there is an increasing interest in intramedullary nailing. Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological.
The expert humeral nail can be inserted into the humeral shaft in both antegrade and retrograde directions. Our objective was to investigate the clinical and radiographic results of the internal fixation using polarus humeral nails for fractures of the proximal humerus. Results of antegrade humeral interlocking nailing in adults a prospective study 2 of 5 were type iii. Techniquenail insertion for pediatric femur opening the femur creating the nail entry point make an incision on the lateral or medial aspect of the distal femur, starting 3 cm above the physis and extending distally for 2.
The role of nailing as opposed to plating of humeral fractures is the subject of continuous debate. For antegrade nail insertion, the patient is placed in a semisited position on a radiolucent table. The insertion point of the straight nail is close to the top of the humeral head. To prevent axillary nerve damage, it is advisable to make small skin incisions and perform blunt dissection to bone, followed by drilling and interlocking. Short 150 mm and long 185320 mm, in 15 mm increments. The nails adapt to the contours of the medullary canal.
Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. The t2 proximal humeral nail is intended for single use only. This study is designed to evaluate the clinical and radiographical results for the displacement of fracture fragments after interlocking intramedullary nailing in hum eral shaft fractures. Retrograde single elastic intramedullary nail in closed simple diaphyseal humeral shaft fractures in children mohamed m h elsayed md1, ahmed f. Antegrade and retrograde nail insertion are equally popular. Pathological fractures of the shaft of the humerus, the journal of. Proximal humeral fractures and intramedullary nailing. Washers nail caps small spider corelock mechanism the affixus natural nail humeral system is a long bone nailing system built on the natural nail and affixus intramedullary platforms. Between 1997 and 2005, 99 acute fractures of the humeral shaft were treated operatively with the unreamed humeral nail uhn, synthes in our level i trauma centre. This metaanalysis compared the clinical outcomes of locking plate with intramedullary nail in the treatment of displaced proximal humeral fractures.
Entry portal for a straight nail is 5 mm posterior to the. The russelltaylor humeral nail smith and nephew, richards was used in all patients. A second nail driving guide wire of the same length is used to measure the length of the medullary canal figure 7. Furthermore, mounting evidence suggests that both the intraarticular portion of the biceps tendon and the extraarticular portion in the bicipital groove can scar down after trauma, causing pain and limiting shoulder range of motion. The humeral nail of medimetal was developed to treat variously located diaphyseal fractures. Orthopaedic division 1450 east brooks road memphis, tn 3 8 1 16 901 3995153 name of device. 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. The laser marking on the end of the nail shows the nail tip. A total of 30 humeral shaft fractures were treated with an antegrade interlocking humeral nail. Rotator cuffsparing approach for antegrade humeral nailing.
The t2 proximal humeral nail is intended to be used for various types of proximal andor diaphyseal fractures of the humerus. The purpose of this study was to evaluate the outcomes of treating humeral shaft fractures using antegrade locked intramedullary nail, compared to the treatment with traditional more aggressive. 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. The first is to use the joysticks to extend and adduct the hu.
Internal fixation of proximal humeral fractures with a. Interlocking intramedullary nailing for nonunion of the. The nails are inserted using an opened or closed technique and can be static, dynamic and compression locked. Centronail humeral nailing system humeral nailing system one design for left or right humerus proximal bend 15 proximal humeral nail.
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. Examples of specific indications according to ao classification include type afractures, dislo. Humeral nonunion is defined as a fracture with no evidence of healing 24 weeks after injury. The nail insertion process must also align humeral proximal fractures. Objective this was a retrospective observational study in patients submitted to intramedullary nail fixation after established or impeding pathological humerusshaft tumoral fracture in the context of disseminated tumoral disease along 22 years of experience at the same institution methods sample with 82 patients and 86 humeral fixations with unreamed rigid interlocking static intramedullary. Results of antegrade humeral interlocking nailing in adults. Treatment of pathological humerusshaft tumoral 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. The talon distalfix humeral nail system is indicated to aid in the alignment and stabilization of humeral fractures, including.
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