Name: Long Humeral Nail System Surgical Technique
Uploaded: 2022-08-31T00:00:00Z
Channel: Arthrex
Description: This animation presents the surgical technique steps for the Arthrex Long Humeral Nail System.

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This animation presents the surgical technique steps for the Arthrex Long Humeral Nail System.

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AN1-000418-en-US | A | Long Humeral Nail System Surgical Technique

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

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Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

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Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

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Long Humeral Nail System Surgical Technique

The Arthrex long humeral nail is intended to treat stable and unstable fractures of the humeral shaft. The nail features three holes proximally, two threaded round locking holes, and one oblong hole that allows for up to five millimeters of in-line compression, as well as a six degree lateral bend to facilitate two entry points. The nail comes in lengths of 20 to 30cm in increments of 2.5cm in diameter of seven, eight, and nine millimeters. The nail utilizes 3.5mm screws distally, along with the choice of a 2 millimeter or 5 millimeter end cap. The system also features in-line compression via a gold compression nut. There are two acceptable entry points for the nail. One is just medial to the greater tuberosity, or in the center of the humeral head, straight down the humeral shaft. Begin by advancing the 3.2mm guide pin into the desired entry point and utilize the The 10.5mm entry reamer over the entry wire. The cannulated awl may also be used with gentle rotations to gain entry to the humeral canal. Insert the ball tip guidewire. If canal reaming is desired, making sure the tip of the wire is just inside the condylar flare. If the fracture is displaced, the fracture reduction tool can be used to help pass the ball tip guidewire down the humeral canal, utilizing the guidewire measuring gauge and black line on the guidewire. Determine the length of the nail needed if in between sizes. It is recommended to size down pass flexible reamers over the ball tip guidewire. It is recommended to ream 0.5mm to one millimeter above the size of the desired nail diameter. If in-line compression is desired, the compression nut must be preloaded into the nail using the long 3.5mm hex driver before attaching the nail to the targeting arm. The compression nut should sit just above the above the dynamic hole so as not to interfere with the drill bit. Attach the nail to the targeting arm by inserting the holding bolt and aligning notches at the top of the nail and the connection point to the targeting arm. Tighten the holding bolt using the 5.0mm hex driver until the nail is securely fastened. The curvature of the nail should go towards the targeting arm once attached. Tighten the targeting jig onto the targeting arm by spinning the thumb wheel until tight. Insert the nail over the guidewire into the entry portal. Gentle rotations may be necessary to fully insert the nail. If insertion proves difficult, thread the impaction pad onto the top of the targeting arm and use a mallet to advance the nail. Depth markings at the end of the targeting arm will help show the depth of the nail on a radiograph. The first line is two millimeters countersunk and the second line is five millimeters. If inline compression is used, countersink the nail at least five millimeters. A K-wires may also be used through the small hole in the in the targeting jig to accurately indicate the top of the nail. For in-line compression. The distal screw must be inserted first. Utilize the 2.9mm drill guide and 2.9mm drill bit to drill bicortical. Utilize the hook tip depth gauge to confirm the depth of the screw needed. Insert the 3.5mm screw using the 2.5mm hex driver and t-handle until the head of the screw is flush to the bone. After distal screw insertion, utilize the line hole on the targeting jig and insert the screw sheath and trocar through a stab incision down to the bone. Remove the trocar and thread in the gold 3.5mm drill sleeve. Advance the 3.5mm. Drill bit through the drill sleeve until just inside the subchondral bone, making sure not to drill into the joint space. Calibrations on the drill bit will indicate the depth of the of the screw needed measurement only corresponds to the threads of the screw and doesn't include the head of the screw. A hook tip depth gauge can also be used for measurement. Once the 3.5mm drill guide is removed. Insert the 5.0mm cancellous interlocking screw through the screw sheath using a 3.5mm hex driver and t-handle until the head of the screw is flush to the bone. Utilizing the same driver used to insert the compression nut, reinsert the driver down the top of the targeting jig and advance the compression nut until adequate compression is achieved across the fracture site. Repeat drilling steps for the remaining proximal screws where needed. If dynamic compression isn't necessary, start with proximal fixation of the nail. Advance the screw sheath and trocar through a stab incision down to the bone. Remove the trocar and thread in the 3.5mm drill sleeve. Advance the 3.5mm drill bit until just inside the subchondral bone. Obtain the screw measurement off calibrations on the drill bit or the hook tip depth gauge. Insert the 5.0mm interlocking screw using the 3.5mm hex driver and t-handle until the head of the screw is flush to the bone. Repeat the process for the remaining proximal screws. For distal screw fixation, drill by cortically utilizing the 2.9mm drill sleeve and drill bit. Once the screw length is determined, use the 2.5mm hex driver and t-handle to insert the 3.5mm screw. Once the targeting jig is removed, a 2mm or 5mm end cap may be used at the top of the nail. The end cap is inserted using the 2.5mm hex driver. Verify all screw lengths, reduction and nail position through radiograph imaging.

Long Humeral Nail System Surgical Technique

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