To further increase rotational stability, the nail can be locked after utilizing the apposition/compression feature. Created with acute fixation options for many challenging fracture
that is built on the Natural Nail and AFFIXUS intramedullary Please select a location and click search to find an associate near you. The nail implants are additionally designed with multiple ability to use a minimally invasive approach in even the most
The subject and predicate devices are indicated for use in the humerus. metaphyseal screws in the construct at a fixed angle at once.Â. proprietary CoreLock⢠technology, integrating a fixed-angle The nail implants specifically, were designed with multiple
Zimmer GmbH Sulzerallee 8 8404 Winterthur Switzerland. Instructional Fitting Video for Biomet® OrthoPak® Non-invasive Bone Growth Stimulator System. build nail on backtable and make sure targeting guide lines up with holes in nail, check sleeves for each interlock hole tighten top locking screw with pumpkin screwdriver to lock together insert nail over guidewire, follow 6° lateral bend of nail, mallet in with strikeplate Declaration For California Compliance Law, UK Modern Slavery Act and California Transparency in Supply Chains Act Statement, Zimmer Biomet Bone Healing Technologies Notice of Privacy Practices. This system offers a complete portfolio of implants and Humeral Nail System offers the competitive advantages of: Compared to Plate and Screw Osteosynthesis : Humeral Nailing System is the realization of superior biomechanical intramedullary stabilization. patterns, the AFFIXUS Natural Nail System was designed with two tools, and color-coded screw instrumentation placement. The AFFIXUS Natural Nail Proximal Humeral Implant showcases the stability. Typical statically locked nails functioning as load bearing devices have reported failure rates in excess of 20%. Any active or suspected latent infection or marked local inflammation in or about the affected area. surgeon and OR staff teams. Do you have any questions for Humeral Nail?
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The system also includes
Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications in postoperative care. Fully Threaded Locking Screws are available for regular locking procedures. The system offers the option of different locking modes : • Static, transverse/oblique • Dynamic • Apposition/compression • Advanced locking. One common Humeral Compression Screw to close the fracture site, and End Caps in six sizes are available to provide an improved fit for every indication to allow nail length adaptation after insertion and to prevent bone ingrowth. The instrument cases are designed in a simple, step-wise, cannulas and locations for fragment targeting and rotational Patient. complex humeral fractures. Knee Animation. include intraoperative options including entry portals, reduction
Please call: 1-800-348-2759. Patients having inadequate tissue coverage over the operative site. space and inventory efficiencies to the hospital. screw options positioned in multi-planar axis, including; AP, ML instruments, which treats a wide range of humeral fractures using Humeral Nail is intended to provide temporary stabilization of various types of fractures, malunions and nonunions of the humerus. 3 Strength and Stability in the Proximal Femur • Optimal lag screw design for resistance to cut-out • Easy-to-use instrumentation and targeting jig, which includes Goal Post technology, Those cookies that we do use are designed to permit you to use the site functions and browse our site in the way that is favorable to you. The targeting guide offers Types of fractures include, but not limited to fractures of the humeral shaft, non-unions, malalignments, pathological humeral fractures, and impending pathological fractures. reduction and screw positioning assistance, with specific pin Copyright © 2020 Lineage Medical, Inc. All rights reserved. Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site. The compression screw is pushed against the proximal Partially Threaded Locking Screw (Shaft Screw) that has been placed in the oblong hole, drawing either the distal or the proximal segment towards the fracture site. simple and efficient instrumentation. Related. In some indications, a controlled apposition/compression of bone fragments can be applied by introducing a compression screw from the top of nail. Please fill this form we will get in touch with you shortly. Partially Threaded Locking Screws (Shaft Screws) are designed for application of apposition/compression. Common 4mm cortical screws simplify the surgical procedure. The AFFIXUS Natural Nail Humeral System is a long bone nailing system Implant utilization that would interfere with anatomical structures or physiological performance. interlocking mechanism into the nail, allowing the user to lock all Relative Contraindications Indications, Precautions and Contraindications. The range of indications for the Expert Proximal Humeral Nail includes humerus fractures in adults in the subcapital area (AO/ASIF classification: A2, A3), or with concurrent avulsion
Cases
platforms. T2 Humeral Nailing System Contributing Surgeons Rupert Beickert, M. D. Senior Trauma Surgeon Murnau Trauma Center Murnau Germany Rosemary Buckle, M. D. ... Nail Selection 16 Nail Insertion 17 Guided Locking Mode (via Target Device) 18 Static Locking Mode 19 Freehand Distal Locking 22 implant options for humeral fractures in both antegrade and retrograde Trabecular Metal™ Total Ankle Animated Demonstration. Need assistance?
Bone stock compromised by disease, infection or prior implantation that can not provide adequate support and/or fixation of the devices. Orthobullets Technique Guides cover information that is "not testable" on ABOS Part I, Confirm Nail Position and Extremity Check, Leg Compartment Release - Single Incision Approach, Leg Compartment Release - Two Incision Approach, Arm Compartment Release - Lateral Approach, Arm Compartment Release - Anteromedial Approach, Shoulder Hemiarthroplasty for Proximal Humerus Fracture, Humerus Shaft ORIF with Posterior Approach, Humerus Shaft Fracture ORIF with Anterolateral Approach, Olecranon Fracture ORIF with Tension Band, Olecranon Fracture ORIF with Plate Fixation, Radial Head Fracture (Mason Type 2) ORIF T-Plate and Kocher Approach, Coronoid Fx - Open Reduction Internal Fixation with Screws, Distal Radius Extra-articular Fracture ORIF with Volar Appr, Distal Radius Intraarticular Fracture ORIF with Dorsal Approach, Distal Radius Fracture Spanning External Fixator, Distal Radius Fracture Non-Spanning External Fixator, Femoral Neck Fracture Closed Reduction and Percutaneous Pinning, Femoral Neck FX ORIF with Cannulated Screws, Femoral Neck Fracture ORIF with Dynamic Hip Screw, Femoral Neck Fracture Cemented Bipolar Hemiarthroplasty, Intertrochanteric Fracture ORIF with Cephalomedullary Nail, Femoral Shaft Fracture Antegrade Intramedullary Nailing, Femoral Shaft Fracture Retrograde Intramedullary Nailing, Distal Femur Fracture ORIF with Single Lateral Plate, Patella Fracture ORIF with Tension Band and K Wires, Tibial Plateau Fracture External Fixation, Bicondylar Tibial Plateau ORIF with Lateral Locking Plate, Tibial Plafond Fracture External Fixation, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Ankle Simple Bimalleolar Fracture ORIF with 1/3 Tubular Plate and Cannulated Screw of Medial Malleol, Ankle Isolated Lateral Malleolus Fracture ORIF with Lag Screw, Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws, RETIRE Transtibial Below the Knee Amputation (BKA), check ipsilateral distal humerus and elbow for concurrent injuries (floating elbow), document neurovascular exam (radial nerve), radiolucent table with or without ipsilateral arm board, rotate bed 90°, patient supine with shoulder at edge of table, c-arm in from foot of bed with monitor parallel to bed, incision 3-4cm along anterolateral aspect of acromion, split fascia and then rotator cuff interval, start point is between greater tuberosity and sulcus in center of humeral head (50% bare area), reduce fracture using traction, varus/vagus, and rotational force applied manually, use entry awl or reamer (~8mm) curved laterally then guidewire to end of humerus, start with size 6-7mm reamer, ream 1.5-2.0mm above size of final nail, insert nail over guidewire following lateral bend, targeting guide 30° anterior to table, mallet in using strikeplate, bury nail 7-10mm, 3-4 proximal locking screws into humeral head through targeting jig, get perfect circles of distal interlock screws, drill and insert, weight-bearing as tolerated, physical therapy, range of motion exercises to elbow/wrist/hand, pendulems for shoulder, before case need to check ipsilateral distal humerus for fracture extension and elbow (floating elbow), check compartments, limb length, rotation, and alignment, need AP/Lat xrays of entire shoulder, humerus, and elbow, location of fracture site will indicate amount of deforming forces: proximal fragment abducted, distal segment in varus, document distal neurovascular status (radial nerve), nonoperative management in coaptation splint and functional brace for fractures with <20° anterior angulation, <30° varus/valgus angulation, <3cm shortening, absolute indications include open fracture with soft tissue injury, vascular injury, brachial plexus injury, relative indications for nailing include pathologic fractures, segmental fractures, severe osteoporosis, skin compromise, polytrauma, humeral intramedullary nailing system, patient supine with ipsilateral shoulder at edge of bed with or without arm board, if no armboard use assistant to manipulate and hold arm, tape down and secure head, chest, and abdomen, rotate bed 90° so that ipsilateral arm is away from Anesthesia, prep and drape entire arm into axilla and over medial clavicle to ensure adequate working area, c-arm in from foot of bed with monitor screen parallel to bed, take initial fluoro AP/Lat of shoulder and humerus to ensure proper positioning during remainder of case, can internal/external rotate arm to get Lat view, incision 3-4cm along anterolateral border of acromion, tenotomy to develop soft tissue plane then cautery through subcutaneous tissue, sharp dissection through fascia, bursa, and rotator interval, mark out anterior, lateral, and posterior borders of acromion, incision and dissection along anterolateral border of acromion down to rotator cuff interval, guidepin start point is between greater tuberosity and sulcus in center of humeral head, aim for 50% bare area, mallet into place, and check on fluoro, divide rotator interval then drive guidewire down canal on power, check AP/Lat fluoro to make sure in center of canal, use lateral entry awl or reamer (~8mm) with soft tissue protector and ream until it hits the stop plate, reduce fracture by using traction, varus/vagus, and rotational force applied manually, once fracture reduced, manually push long balltip guidewire past fracture site using T-handle (with slight bend at tip), mallet to distal aspect of humerus (olecranon fossa), check on fluoro AP/Lat, use radiolucent ruler to measure appropriate nail length on AP fluoro of shoulder, need to recheck fracture site to ensure no gapping in order to get accurate length, use ruler on contralateral side to measure intact humerus if segmental comminution exists, start with size 6-7mm reamer, then ream up 0.5-1.0mm with each reamer, push through entry hole before reaming to avoid reaming out anterior cortex, check chatter from reamer feedback and diaphyseal fit on fluoro AP, “ream and run”: ream up to fracture site with smaller reamers then push through fracture site and restart reamer full speed to avoid eccentric reaming, don’t stop reamer in canal with larger reamer sizes (avoids reamer head from getting stuck), build nail on backtable and make sure targeting guide lines up with holes in nail, check sleeves for each interlock hole, tighten top locking screw with pumpkin screwdriver to lock together, insert nail over guidewire, follow 6° lateral bend of nail, mallet in with strikeplate, targeting jig should be 30° anterior to bed for proper alignment, hold nail by handle, not the targeting guide, mallet or manually advance to fracture site, check on fluoro AP/Lat, manually advance nail past the fracture site to avoid iatrogenic comminution or development of new fracture lines possible with use of the mallet, insert nail completely and seat fully, check seating in humeral head, need to bury nail ~7-10mm to decrease incidence of shoulder pain, check on AP fluoro to see where humeral head interlock screws will be located, can insert 3-4 (5mm) proximal interlock screws, multiplanar screws for right vs. left sides, mark skin with triple sleeve through jig, use 15blade through skin and deep fascia, place inner sleeves (x2) into guide, push guides down to bone, insert screw and check length and placement on fluoro to ensure no articular penetration on multiple fluoro views, can add endcap into top of nail to lock in most proximal interlock screw and prevent bony ingrowth into top of nail, use pumpkin screwdriver to remove locking screw from nail and remove handle and targeting guide, recheck fracture site and reduction prior to insertion of distal interlock screws, if gapping at fracture use hand to strike elbow and compress across fracture site, place arm on mayo stand or stack of towels and move to distal nail at elbow, take AP fluoro for perfect circles technique for interlocking screws, c-arm stays still and rotate arm to get perfect circles (anterolateral direction for screws), once distal interlock holes appear as perfect circles, use hemostat handle to localize holes, mag x2 in with fluoro, 10blade through skin, hemostat spread down to bone, need to visualize bone in order to prevent injury to surrounding nerves, radial nerve can be damaged with lateral to medial interlock screws, musculocutaneous nerve with anterior to posterior screws, place drill through hole, then make drill perpendicular to C-arm beam and drill through first cortex and nail, stop at 2nd cortex, measure (add 5mm to length to add 2, while still in perfect circles lat fluoro, complete 2nd distal interlock screw and measure, c-arm to AP position to get out of the way, insert both interlock screws, take final AP/Lat of distal and proximal aspects of nail and fracture, check limb length, rotation, and alignment, strongly flush out nail insertion site and interlocking screw sites with saline bulb irrigation, cauterize peripheral bleeding vessels, close rotator cuff and fascia with 0-vicryl or 2-0 Ethibond sutures, subcutaneous and skin closure with 2-0 vicryl and staples, soft incision dressings over shoulder and proximal/distal interlock incisions, weight-bearing as tolerated, physical therapy, immediate range of motion exercises to elbow/wrist/hand to reduce swelling, pendulems for shoulder range of motion, recheck neurovascular exam (radial nerve), continue physical therapy and range of motion exercises, screw penetration into articular surface, nerve injury (radial nerve with lateral to medial interlock screws, musculocutaneous nerve with anterior to posterior screws).
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