Clinical example using a, b, c, and e level screws 1 features anatomicallyshaped ten suture holes around the perimeter of the proximal end proximal locking holes accept 3. Nevertheless, modern humeral nail families include both a diaphyseal nail and a proximal nail expert humeral nail ehnao or t2 humeral nail stryker and others. Although axillary nerve injury has been reported, no study has compared the safety of the proximal locking options relative to the axillary nerve and the ascending branch of the anterior circumflex artery. Treatment of proximal humerus fractures with the stryker. The purpose of the study was to prospectively evaluate the outcomes of phf fixation with a locking blade nail lbn or locking plate philos osteosynthesis in a. Intramedullary fixation of proximal humerus fractures. Distal humeral component distal end accepts bearing insert, axle bushing and axle pin and provides an.
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. Iuh methodist hospital orthopedic trauma service disclosures stryker trauma research and design consultant speaker board stock. Treatment of proximal humeral fractures with im nails. The new metal head is attached to a stem, which is inserted. System, stryker osteosynthesis has created a humeral implant. Displaced or unstable fractures require open reduction and internal fixation. To complement the t2 nailing system, stryker osteosynthesis has created a humeral implant. Internal fixation of proximal humerus fractures using the. Phn has been designed for antegrade insertion into the proximal humeral shaft. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. 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. Hydroset injectable ha bone substitute inion otps biodegradable plates, screws and pins.
Fractures of the proximal humerus including 2part surgical neck fractures, 3part fractures and 4part fractures fractures of the proximal humerus with diaphyseal extension diaphyseal fractures of the humeral. To allow easy access to the proximal humerus, it is helpful and recommended to place the carm on the opposite side of the table of the injured limb. The expert humeral nail can be inserted into the humeral shaft in both antegrade and retrograde directions. Short humeral nails the short humeral nail enables osteosynthesis of armbone head. Anglestable intramedullary nailing of proximal humerus fractures with the phn proximal humeral nail. Figure 1 a fixed humeral nail is locked proximally and. Intramedullary nail for proximal humerus fractures. The proximal end of the nail has two holes ml and two holes ap to accept up to four locking screws and it. In either approach, the surgeon should consider the appositioncompression feature of the t2 humeral nail, knowing that 6mm of active apposition compression is possible, prior to deter. Return to normal function and motion may require 3 to 4 months overall goals. Bony healing occurs usually within 6 to 8 weeks in adults 2.
Types of fractures include, but not limited to fractures of the humeral shaft, nonunions, malalignments, pathological humeral fractures, and impending pathological fractures. The standardised proximal spiralblade locking ensures sufficient anchoring even in an osteoporotic humeral head. Flexible intramedullary nailing for treatment of proximal. Fractures were classified into 2part n8, 3part n17, and 4part n3, and corresponded. Intramedullary nail for treating proximal humerus fractures. A new rotator interval approach for antegrade humeral.
Methods sixtyone consecutive patients with acute unilateral displaced proximal humerus fractures. Although based on the wellknown t2 platform, the t2 proximal humeral nail design incorporates a. Proximal humerus fracture book twin cities orthopedics. It can be used universally for the left and right humeri. Our objective was to investigate the clinical and radiographic results of the internal fixation using polarus humeral nails for fractures of the proximal humerus. The mean total operative time was 56 21103 min for the humeral shaft fractures, 67 39120 min for proximal humeral fractures and 71 341 min for proximal humeral physeal injuries.
External rotation of the humeral head is then required to bring the entry point into the incision area. There is little guidance on which patients are likely to do well with humeral nailing. Monoaxial locking plate system for treating proximal humerus fractures. One implant, two approaches stryker trauma has created a new generation locking nail system, bringing. 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. 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.
Entry portal for a straight nail is 5 mm posterior to the. Proximal extension of the skin incision with resection of the cal may also be applicable in difficult cases. Although most fractures can be treated conservatively with. Humeral nailing system stryker pdf catalogs technical.
The t2 proximal humeral nail is intended to be used for various types of proximal andor diaphyseal fractures of the humerus. Treatment of proximal humerus fractures with the stryker t2 proximal humeral nail. Versanail humeral proximal nailing system 8 patient positioning position the patient supine in the beach chair position on a radiolucent table figure 1. Internal fixation of proximal humeral fractures with a. Treatment of proximal humerus fractures with the stryker t2. Pdf intramedullary nailing of the proximal humerus.
Humeral nail designs have undergone significant innovation during the past 40 years and now can provide stable. The axis of the three bores are circumferentially offset in respect to each other in planes perpendicular to the longitudinal axis of the shaft. Pdf proximal humerus fractures are the third most common fracture in the elderly. Six different commercially available proximal humeral nails were implanted. Intramedullary locked nailing is becoming a popular alternative treatment, especially for easier fracture patterns. 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. Sirus zimmer and stryker t2 phn proximal humeral nail. This involves removing the humeral head, and replacing it with a new metal head. Retrograde humeral nail biomet retrograde reamedunreamed 21,22 russelltaylor humeral nail smith and nephew antegrade reamed 2328 t 2 stryker antegraderetrograde reamedunreamed uni. The entry point for the talon distalfix humeral nail is in line with the medullary canal in the lateral view. Mrs upper extremity surgical protocol mrs distal humerus the mrs distal humerus and ulna system is designed for a universal fit with the mrs proximal humerus system and solar ulna components. Solid humeral nail uhn and proximal humeral nail phn.
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. 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 trauma has created a new generation humeral implant. Conclusion we find this rotator interval approach safe and effective to cope with 2part humeral neck and humeral shaft fractures. Operative time for humeral shaft fractures was significantly lower than for proximal humeral injuries p 0. Increase rom while protecting the fracture site you can be slightly more. A humeral nail for the surgical care of fractures of the proximal humerus, with a shaft which has a longitudinal axis and is provided in a proximal portion with at least transverse bores spaced apart in the axial direction. Anglestable intramedullary nailing of proximal humerus fractures with the. Although based on the wellknown t2 platform, the t2 proximal humeral nail design incorporates a number of unique features. Materials and methods between october 2004 and january 2007, 24 women and 4 men aged 38 to 87 mean, 65 years underwent intramedullary nailing for displaced proximal humeral fractures. Proximal humeral fractures and intramedullary nailing. 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.
Tighten the humeral nail guide bolt using the guide bolt wrench 717514. Short 150 mm and long 185320 mm, in 15 mm increments. Proximal humerus fractures are one of the most common fractures. The trigen humeral nail provides new possibilities for the treatment of proximal humeral fractures and humeral shaft fractures. Attach the proximal drop 717511 to the lateral arm of the nail drill guide to complete the assembly. Uniflex humeral nail surgical technique zimmer biomet. More variants of locking allow good fixation of short fragments and optimal reposition of the fractures. This study showed that the proximal humeral nail and the rigid internal fixator are stronger than the semielastic locked plate and the synthes tplate for unstable subcapital proximal humeral. Phn in 61 displaced fractures of the proximal humerus and, second, to identify which groups of patients are likely to do.
Pdf anglestable intramedullary nailing of proximal humerus. Modern proximal humeral nail designs and techniques assist the surgeon in adhering to these principles and have demonstrated promising outcomes. Intramedullary nailing of humeral head and humeral shaft. Locking nail versus locking plate for proximal humeral. Short and long humeral nail medin proximal humeral nails. Intramedullary nailing for displaced proximal humeral. Distal locking screws for the 18cm or longer humeral nails should be targeted using a freehand technique. Consult strykers entire humeral nailing system catalogue on medicalexpo. T2 proximal humeral nail intermedulary nail system t2 humeral nail intermedulary nail system. Attach the impactor 717513 to the humeral nail guide bolt. Winkelstabile marknagelosteosynthese fur proximale. Proximal humeral fractures phfs are the third most common fracture in older patients.
This publication sets forth detailed recommended procedures for using. The retrograde nail length is determined by measuring the distance from 1cm above the olecranon fossa to the center of the humeral head. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Humeral shaft fractures and nailing approach there is still an ongoing discussion about the approach for humeral nailing 12, 19. From a populationbased implant design, a patented screwtoplate interface, and streamlined instrumentation, our focus was on creating a welldesigned plating system, giving you more time to focus on other things.