Synthes MultiLoc Proximal Humeral Nail Technique Manual Download Page 3

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Introduction

Surgical Technique

Product Information

Image intensiﬁer control

MultiLoc Proximal Humeral Nail Technique Guide

Synthes

Table of Contents

MultiLoc Proximal Humeral Nail

Screw Configuration

AO Principles

Indications

Clinical Cases

Patient Positioning

Approach

Opening the Humerus

Nail Insertion

Nail Positioning

Proximal Locking

MultiLoc Screws 22
3.5 mm Locking Screws

Distal Locking

End Cap Insertion

Implant Removal (Optional)

Implants

Instruments

Set Lists

Summary of Contents for MultiLoc Proximal Humeral Nail

Page 1: ...MultiLoc Proximal Humeral Nail Proximal humeral nail with multiple locking options for simple and complex fractures Technique Guide...

Page 2: ......

Page 3: ...Proximal Humeral Nail 2 Screw Configuration 4 AO Principles 5 Indications 6 Clinical Cases 7 Patient Positioning 10 Approach 11 Opening the Humerus 13 Nail Insertion 16 Nail Positioning 18 Proximal Lo...

Page 4: ...nt prominence 3 Four suture holes per screw for attachment of the rotator cuff muscles 4 Option for secondary 3 5 mm locking screws for improved stability where needed MultiLoc Proximal Humeral Nail 2...

Page 5: ...k material with densities of 5 5 pcf pounds per cubic foot 7 5 pcf and 10 pcf Failure was defined as varus collapse of 10 mm or cutout of the proximal screws Results showed as much as a 45 increase in...

Page 6: ...eases the stability of the construct It may be used in fractures with a lesser tuberosity fragment if the fragment is large enough to accommodate the screwhead Do not insert a 3 5 mm locking screw in...

Page 7: ...duction Fracture reduction and fixation to restore anatomical relationships Stable fixation Stability by fixation or splintage as the personality of the fracture and the injury requires Preservation o...

Page 8: ...Loc Proximal Humeral Nail Technique Guide The MultiLoc Proximal Humeral Nail is indicated for fractures of the proximal humerus including 2 part surgical neck fractures 3 part fractures 4 part fractur...

Page 9: ...ld woman Simple fall Treatment with 8 0 mm MultiLoc nail 3 MultiLoc screws levels A B and D Standard distal locking Preoperative AP view Postoperative AP view Preoperative scapular Y view Postoperativ...

Page 10: ...tive rehabilitation Treatment with 9 5 mm MultiLoc nail 3 MultiLoc screws levels A B and D 3 5 mm locking screw screw in screw level A Ascending screw with ASLS Distal locking with ASLS 8 Synthes Mult...

Page 11: ...Simple fall Treat ment with 8 0 mm MultiLoc nail 3 MultiLoc screws levels A B and D 3 5 mm locking screw screw in screw level A Suture fixation of lesser tuberosity fragment Standard distal locking P...

Page 12: ...of the entire humerus in two planes e g at the head of the patient or contralateral to the injured arm 10 Synthes MultiLoc Proximal Humeral Nail Technique Guide A modified supine position on a complet...

Page 13: ...le third along its fibers and retract it In complex fractures a better view may be achieved by partially detaching the deltoid muscle from the anterior border of the acromion Caution Do not extend the...

Page 14: ...Reduce the fracture via indirect reduction maneuvers traction sutures an elevator or Schanz screws or Kirschner wires used as joysticks If necessary use Kirschner wires to hold the fragments tem porar...

Page 15: ...ry canal in both AP and lateral views This point is located posterolateral to the biceps tendon and medial to the sulcus between the greater tuberosity and the humeral head Note If the acromion inhibi...

Page 16: ...holding sutures and retractors to obtain access to the operative field Advance the guide rod until its stop reaches the bone surface Remove the small universal chuck Continue with Step 3 Option A Cau...

Page 17: ...llow drill bit protection sleeve and guide rod Note Use the 11 5 mm hollow drill bit marked with a gold band for the 9 5 mm MultiLoc Proximal Humeral Nail For all other nails use the 10 0 mm hollow dr...

Page 18: ...width across flats Orient the insertion handle laterally and match the geometry of the insertion handle to the nail Pass the connecting screw through the insertion handle and into the nail Secure the...

Page 19: ...the diaphysis Check the nail position in AP and lateral views Caution The proximal end of the nail must be inserted below the humeral head surface to avoid impingement Warning Do not use a hammer as...

Page 20: ...re the aiming arm shows RIGHT if used for the right humerus and LEFT if used for the left humerus 18 Synthes MultiLoc Proximal Humeral Nail Technique Guide Optional technique Assemble anterior aiming...

Page 21: ...Synthes 19 Optional technique Ascending screw level E If the ascending screw is used place a 2 5 mm Kirschner wire through the hole in the anterior aiming arm marked ASCEND Adjust the position of the...

Page 22: ...rough the most proximal hole of the lateral aiming arm level A Insert a second trocar assembly through the anterior hole of the lateral aiming arm level D The screw on level D should be placed as ante...

Page 23: ...aiming arm Caution Ensure that the tip of the trocar touches the tip of the lesser tuberosity This helps to prevent irritation of the long biceps tendon or the ascending branch of the anterior circum...

Page 24: ...ill sleeve Caution Do not penetrate the articular surface Proximal Locking MultiLoc Screws Alternative technique Measure using depth probe Instrument 03 019 029 Depth Probe for MultiLoc Humeral Nailin...

Page 25: ...l Nail Technique Guide Synthes 23 Option Overdrill in hard bone Instrument 03 019 018 6 5 mm Drill Bit conical with stop In hard bone overdrill the lateral cortex with the conical drill bit to counter...

Page 26: ...otection sleeve until it is countersunk Ensure that the final position of the screwdriver handle is perpendicular to the nail with the arrow pointing posteriorly Verify the position of the screw under...

Page 27: ...to lock the centering sleeve into the MultiLoc screw Remove the screwdriver and protection sleeve Notes Do not insert a 3 5 mm locking screw through the anterior screw level C The centering sleeve ma...

Page 28: ...e for 03 019 019 Remove the lateral aiming arm If not done so previously attach a centering sleeve to the MultiLoc screw Gently tilt the centering sleeve anteriorly and lock the drill sleeve in the ce...

Page 29: ...is properly locked in the centering sleeve Do not change the position of the centering sleeve Alternative technique Measure using depth probe Instrument 03 019 029 Depth Probe for MultiLoc Humeral Na...

Page 30: ...g Assemble the torque limiting attachment handle and screw driver shaft Select the appropriate length 3 5 mm locking screw and insert it through the centering sleeve Tighten the screw until a click is...

Page 31: ...m Knob To insert the remaining 3 5 mm locking screws repeat Steps 1 through 3 Carefully inspect the final position of all 3 5 mm locking screws under imaging in different planes and ensure that they d...

Page 32: ...rough one of the distal holes in the aiming arm Make a skin incision and dissect carefully to the bone to avoid injury to the surrounding neurovascular structure and soft tissue Advance the trocar ass...

Page 33: ...Angular Stable Locking System ASLS Figure 1 may be useful in cases where increased stability is needed as in fractures closer to the metaphyseal area or in poor quality bone For additional information...

Page 34: ...be used for screw length determination Assemble the depth gauge with its outer sleeve Insert the depth gauge through the protection sleeve Press the outer part of the depth gauge firmly to the cortex...

Page 35: ...ew repeat Steps 1 through 3 To insert the ascending screw follow the same procedure Remove the lateral aiming arm 3 Insert 4 0 mm locking screw Instrument 03 019 020 StarDrive Screwdriver T25 with cou...

Page 36: ...6 Combination Wrench 11 0 mm width across flats Slide the end cap ruler over the proximal groove of the inser tion handle Push the ruler down to the bone and read the end cap length directly off the r...

Page 37: ...ertion handle and tighten the knob Insert a 2 5 mm Kirschner wire through the corresponding end cap hole in the proximal portion of the aiming arm Estimate the extension length using an AP image of th...

Page 38: ...ent If in doubt choose a shorter end cap To minimize the chance of cross threading turn the end cap counterclockwise until the thread of the end cap aligns with the nail End Cap Insertion 3 Insert sut...

Page 39: ...dle and remove all 3 5 mm locking screws 1 Remove end cap Instruments 03 019 020 StarDrive Screwdriver T25 with coupling for 03 019 019 330 mm 03 019 024 Extraction Screw for MultiLoc Humeral Nailing...

Page 40: ...the extraction shaft and handle and remove all MultiLoc screws Note If 3 5 mm locking screws were used remove them first Implant Removal Optional 4 Remove 4 0 mm locking screws Instrument 03 019 020...

Page 41: ...nique Guide Synthes 39 5 Remove nail Instrument 03 019 028 Combined Hammer 360 grams Before nail extraction ensure all locking screws are removed Remove the nail If resistance is encountered use gentl...

Page 42: ...itanium 6 aluminium 7 niobium alloy Diameters 8 0 mm proximal diameter 9 5 mm 9 5 mm proximal diameter 11 0 mm Color Blue Length 160 mm Cross section Round 04 016 034S 8 0 mm right 04 016 035S 8 0 mm...

Page 43: ...whead with suture holes Length mm 04 019 020 20 04 019 022 22 04 019 024 24 04 019 026 26 04 019 028 28 04 019 030 30 04 019 032 32 04 019 034 34 04 019 036 36 04 019 038 38 04 019 040 40 Length mm 04...

Page 44: ...mm Core diameter 2 9 mm T15 StarDrive recess Fully threaded Self tapping Length mm 412 109 26 412 110 28 412 111 30 412 112 32 412 113 34 412 115 36 412 116 38 Available nonsterile or sterile packed...

Page 45: ...0 20 04 005 412 22 04 005 414 24 04 005 416 26 04 005 418 28 04 005 420 30 04 005 422 32 04 005 424 34 04 005 426 36 04 005 428 38 04 005 430 40 04 005 432 42 04 005 434 44 04 005 436 46 Length mm 04...

Page 46: ...ingrowth Diameter 6 0 mm StarDrive T25 recess 2 mm 5 mm 10 mm or 15 mm extension Extends nail height if nail is overinserted Protects nail threads from tissue ingrowth Diameter 9 5 mm T25 StarDrive r...

Page 47: ...03 010 063 12 0 mm 8 0 mm Protection Sleeve 188 mm 03 010 064 8 0 mm 3 2 mm Drill Sleeve 200 mm 03 010 069 3 2 mm Trocar 03 019 003 10 0 mm Hollow Drill Bit for MultiLoc Humeral Nailing System 03 019...

Page 48: ...ide 03 019 008 Aiming Arm lateral for MultiLoc Proximal Humeral Nail 03 019 007 Connecting Screw cannulated for MultiLoc Humeral Nail 03 019 006 Insertion Handle for MultiLoc Proximal Humeral Nail 03...

Page 49: ...mm 03 019 015 3 8 mm Trocar for 03 019 014 03 019 014 10 0 mm 3 8 mm Drill Sleeve for 03 019 013 03 019 013 13 0 mm 10 0 mm Protection Sleeve for 4 5 mm Titanium MultiLoc Screws 150 mm 03 019 010 Extr...

Page 50: ...ntering Sleeve for 3 5 mm Titanium Locking Screws and 4 5 mm Titanium MultiLoc Screws 03 019 020 StarDrive Screwdriver T25 with Coupling for 03 019 019 330 mm 03 019 021 5 8 mm 2 8 mm Drill Sleeve for...

Page 51: ...rewdriver for 4 5 mm Titanium MultiLoc Screws self retaining 330 mm 03 019 026 2 5 mm Guide Rod with Stop trocar tip 230 mm 03 019 027 Protection Sleeve for 03 019 003 and 03 019 004 03 019 028 Combin...

Page 52: ...16 1 6 mm Kirschner Wire trocar point 150 mm 292 26 2 5 mm Kirschner Wire trocar point 285 mm 310 284 2 8 mm Drill Bit quick coupling 165 mm 314 116 StarDrive Screwdriver Shaft T15 quick coupling 319...

Page 53: ...Combination Wrench 11 0 mm width across flats 393 105 Small Universal Chuck with T Handle 511 773 Torque Limiting Attachment 1 5 Nm quick coupling MultiLoc Proximal Humeral Nail Technique Guide Synth...

Page 54: ...rile 03 019 004S 11 5 mm Hollow Drill Bit for 9 5 mm MultiLoc Proximal Humeral Nail sterile 03 019 016S 3 8 mm Three Fluted Drill Bit quick coupling calibrated 270 mm for 03 019 014 sterile 03 019 018...

Page 55: ...009 310 288 2 8 mm Drill Bit 165 mm quick coupling 397 705 Handle quick coupling 511 770 Torque Limiting Attachment 1 5 Nm MultiLoc Proximal Humeral Nail Technique Guide Synthes 53 03 019 030 Aiming A...

Page 56: ...ion Shaft for 4 5 mm Titanium MultiLoc Screws quick coupling 03 019 013 13 0 mm 10 0 mm Protection Sleeve for 4 5 mm Titanium MultiLoc Screws 150 mm 3 ea 03 019 014 10 0 mm 3 8 mm Drill Sleeve for 03...

Page 57: ...019 003 and 03 019 004 03 019 028 Combined Hammer 360 grams 03 019 029 Depth Probe for MultiLoc Humeral Nail System 292 16 1 6 mm Kirschner Wire 150 mm trocar point 292 26 2 5 mm Kirschner Wire 285 mm...

Page 58: ...24 mm 04 005 416S 26 mm 04 005 418S 28 mm 04 005 420S 30 mm 04 005 422S 32 mm 04 005 424S 34 mm 04 005 426S 36 mm 04 005 428S 38 mm 04 005 430S 40 mm 04 005 432S 42 mm 04 005 434S 44 mm 04 005 436S 4...

Page 59: ...mm 04 019 028 28 mm 04 019 030 30 mm 04 019 032 32 mm 04 019 034 34 mm 04 019 036 36 mm 04 019 038 38 mm 04 019 040 40 mm 04 019 042 42 mm 04 019 044 44 mm 04 019 046 46 mm 04 019 048 48 mm 04 019 050...

Page 60: ...s affiliates Printed in U S A 7 11 J9981 A Synthes USA 1302 Wrights Lane East West Chester PA 19380 Telephone 610 719 5000 To order 800 523 0322 Fax 610 251 9056 Synthes Canada Ltd 2566 Meadowpine Bou...

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