Humerus Recovery

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    T2Humeral Nailing System

    Operative Technique

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    T2 Hmeral Nailin Sstem

    Contributing Surgeons

    Rpert Beicert, M. D.Senior Trauma SurgeonMurnau Trauma CenterMurnauGermany

    Rosemar Bcle, M. D.

    Orthopaedic Associates, L. L. P.Clinical InstructorUniversity o Texas Medical SchoolHouston, TexasUSA

    Prof. Dr. med. Voler Bhren

    Chie o Surgical ServicesMedical Director o Murnau Trauma CenterMurnauGermany

    Michael D. Mason, D. O.

    Assistant Proessor o Orthopaedic SurgeryTuts University School o MedicineNew England Baptist Bone & Joint Institute

    Boston, MassachusettsUSA

    This publication sets orth detailedrecommended procedures or usingStryker Osteosynthesis devices andinstruments.

    It oers guidance that you shouldheed, but, as with any such technicalguide, each surgeon must consider

    the particular needs o each patientand make appropriate adjustmentswhen and as required.

    A workshop training is required priorto rst surgery.

    All non-sterile devices must becleaned and sterilized beore use.Follow the instructions provided inour reprocessing guide (L24002000).Multi-component instruments must

    be disassembled or cleaning. Pleasereer to the corresponding assembly/disassembly instructions

    See package insert (L22000007) ora complete list o potential adverseeects, contraindications, warningsand precautions. The surgeon mustdiscuss all relevant risks, including thenite lietime o the device, with thepatient, when necessary.

    Warning:

    All bone screws reerenced inthis document here are notapproved or screw attachment orxation to the posterior elements(pedicles) o the cervical, thoracicor lumbar spine.

    2

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    Page

    1. Introduction 4

    Implant Features 4

    Technical Details 5

    Instrument Features 62. Reerences 7

    3. Indications, Precautions and Contraindications 8

    Indications 8

    Precautions 8

    Relative Contraindications 8

    4. Pre-operative Planning 9

    5. Locking Options 10

    6. Operative Technique Antegrade Technique 12

    Patient Positioning and Fracture Reduction 12

    Incision 12

    Entry Point 13

    Unreamed Technique 14

    Reamed Technique 14

    Nail Selection 16

    Nail Insertion 17

    Guided Locking Mode (via Target Device) 18

    Static Locking Mode 19

    Freehand Distal Locking 22

    End Cap Insertion 24

    Dynamic Locking Mode 24

    Apposition /Compression Locking Mode 25

    Advanced Locking Mode 27

    Nail Removal 28

    7. Operative Technique Antegrade Technique 29

    Patient Positioning 29

    Incision 29

    Entry Point 30

    Unreamed Technique 30

    Reamed Technique 31

    Nail Selection 32

    Nail Insertion 32

    Guided Locking Mode (via Target Device) 35

    Static Locking Mode 36

    Freehand Proximal Locking 39

    End Cap Insertion 40

    Dynamic Locking Mode 40

    Apposition /Compression Locking Mode 41

    Advanced Locking Mode 43

    Nail Removal 44

    Ordering Inormation Implants 45

    Ordering Inormation Instruments 47

    Contents

    3

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    Introdction

    Over the past several decades ante-grade humeral nailinghas becomethe treatment o choice or mosthumeral shat ractures. Retrogradehumeral nailinghas expanded the

    use o intramedullary nails.

    Studies have shown the ollow-ing benets to be associated withHumeral Nailing :Brie operative time (1)Minimal morbidity (1)Early return to unction o theextremity (2)In 90% o the cases, no external sup-port is needed (1, 2)Closed technique (4)

    Low inection rate (2, 5, 6)Very good pain relie in stabilization opathological ractures (2, 4)

    Compared to Plate and ScrewOsteosynthesis :Minimal damage to muscle, connec-tive tissue and vasculature (1, 3, 7)Reduced periosteal stripping and con-

    comitant sot tissue damage(1)Fewer radial nerve palsies (3, 4)Designed or load sharing instead oload bearing (2)Cosmetically smaller incision

    The T2 Humeral Nailing System isone o the rst humeral nailingsystems to oer an option or either anantegrade or a retrograde approach torepair ractures o the humerus.

    One Implant, Two Approaches

    Stryker Osteosynthesis has created alocking nail system, bring-ing togetherall the capabilities and benets o sep-arate antegrade and retrograde nailingsystems to create a single, integratedsurgical resource or xation o long-

    bone ractures.Furthermore, the development othe T2 Humeral Nailing System oersthe competitive advantages o :

    Dual nailing approach : Antegradeand Retrograde

    Accommodating reamed or

    unreamed procedures Static, controlled dynamic and

    apposition/compression lockingoptions

    Advanced Locking Mode forincreased rotational stability.

    Through the development o a com-mon, streamlined and intuitive surgi-

    cal approach, both in principle and indetail, the T2 Humeral Nailing Systemoers signicantly increased speedand unctionality or the treatmento ractures as well as simpliying thetraining requirements or all personnelinvolved.

    The T2 Humeral Nailing System is therealization o superior biomechanicalintramedullary stabilization.

    The system oers the option odierent locking modes : Static, transverse /oblique Dynamic Apposition/compression

    Advanced locking

    In some indications, a controlledapposition/compression o bone rag-ments can be applied by introducinga compression screw rom the top onail. To urther increase rotationalstability, the nail can be locked aterutilizing the apposition/compressioneature.

    The benecial eect o apposition/

    compression in treating long-boneractures in cases involving transverseand short oblique ractures that areaxial ly stable is well documented(15, 16, 19).

    The compression screw is pushedagainst the proximal PartiallyThreaded Locking Screw (ShatScrew) that has been placed in theoblong hole, drawing either the distalor the proximal segment towards theracture site. In stable ractures, thishas the biomechanical advantage ocreating active circumerential com-

    pression to the racture site, transer-ring axial load to the bone, andreducing the unction o the nail as aload bearing device (17).

    This ability to transer load back tothe bone can reduce the incidence oimplant ailure secondary to atigue.Typical statical ly locked nails unc-tioning as load bearing devices havereported ailure rates in excess o 20%(18).

    Common 4mm cortical screws sim-pliy the surgical procedure. FullyThreaded Locking Screws are avail-able or regular locking procedures.Partially Threaded Locking Screws(Shat Screws) are designed or appli-cation o apposition/compression.

    One common Humeral Compression

    Screwto close the racture site, andEnd Caps in six sizes are available toprovide an improved t or every indi-cation to allow nail length adaptationater insertion and to prevent boneingrowth.

    All implants o the T2 HumeralNailing System are cannulatedand made oType II anodizedtitanium alloy (Ti6AL4V) orenhanced biomechanical and bio-

    medical perormance.

    See the detailed chart on the next pageor the design specications and sizeoerings.

    Implant Features

    4

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    Technical Details

    Introdction

    Bend, 6

    CompressionRange*

    SLOT

    0mm

    12

    23

    28

    38

    62

    30

    36

    48mm

    28

    10

    0mm

    18

    Bend, 4

    Nails

    Diameter 79mmSizes 140320mm

    * Compression Range

    Total Length o Slot 10mm

    Less Screw Diameter () 4mm

    Maximum Movement o Screw 6mm

    Hmers Advanced

    Compression Screw

    (Diameter = 6mm)

    4.0mm Fll Threaded

    Locin Screws

    L = 2060mm

    4.0mm Partiall Threaded

    Locin Screws

    (Shat Screws)L = 2060mm

    End Caps

    Standard +5mm +10mm +15mm +20mm +25mm

    5

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    The major advantage o the instru-ment system is a breakthrough in theintegration o the instrument plat-orm which can be used not only orthe complete T2 Nailing System, butwill be the platorm or all utureStryker nail ing systems, thereby reduc-ing complexity and inventory.

    The instrument platorm oersadvanced precision and usability, andeatures ergonomically styledtargeting devices.

    Instrument FeaturesSymbol coding on the instrumentsindicates the type o procedure, andmust not be mixed.

    Smbol

    Square = Long instruments

    Triangular = Short instruments

    Drills

    Drills feature color coded rings :

    3.5mm = OrangeFor 4.0mm Fully Threaded LockingScrews and or the second cortexwhen using 4.0mm Partially ThreadedLocking Screws (Shat Screws).

    4.0mm = GreyFor the rst cortex when using 4.0mmPartially Threaded Locking Screws(Shat Screws).

    Introdction

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    16. O. Gonschorek, G. O. Homann,V. Bhren, InterlockingCompression Nailing : A reporton 402 Applications, Arch OrthopTrauma Surg (1998)117 : 430437.

    17. T. E. Richardson, M. Voor,D. Seligson, Fracture SiteCompression and Motion withThree Types o IntramedullaryFixation o the Femur,In : Osteosynthese International(1998), 6 : 261264.

    18. Hutson et al., Mechanical Failureso Intramedullary Tibial NailsApplied without Reaming, In :Clin. Orthop. (1995), 315 : 129137.

    19. Bhren V., Kompressionsnagelunglanger Rhrenknochen,Unallchirurg 103,2000, 708720.

    20. Mehdi Mousavi, et al., PressureChanges During Reaming withDifferent Parameters and Reamer

    Designs, Clinical Orthopaedicsand Related Research, Number 373,