Versanail ® Humeral Proximal Nailing System Product Rationale & Surgical Technique

Note: This brochure presents a surgical technique available for use with the Biomet, Inc., VersaNail® Platform instruments and implants. Surgeons may need to make modifications as appropriate in their own surgical technique with these devices depending on individual patient requirements. 1

Versanail ® Humeral Proximal Nailing System Intramedullary Fixation of Humeral Proximal Fractures • Nail design to treat simple to complex proximal humeral fractures The VersaNail® Humeral Proximal Nail is part of a long bone nailing system that offers a complete portfolio of implants and instruments based on a single, standardized technology platform. The Humeral Proximal Nailing System from the VersaNail® Platform offers options to treat a range of proximal humeral fractures with one implant. The implant includes a proprietary locking sleeve technology which locks all three proximal screws,...

Versanail ® Humeral Proximal Nailing System The Humeral Proximal Nail is designed to treat proximal humeral fractures. Proximal Screws: • Unique proximal screw configuration enhances fragment fixation • 4.8 mm cancellous screws • 2 L-M transverse screws: 30 degrees from oblique screw • 1 L-M oblique screw: 45 degrees for provisional fixation 3.0 mm cannulation accepts guide wire during nail insertion S izes: 8 mm and 10 mm diameter Length: 150 mm Distal Screws: • 3.5 mm for 8 mm nail • 4.5 mm for 10

Humeral Proximal Jig The proximal humeral trigger jig is designed with the jig mechanics up and out of the way so that the entry site can be targeted from a distance. The targeting arm rotates with the push of a button to target the proximal locking options. The rotating design also allows the jig to be repositioned without disassembly for convenience during the nailing procedure to improve visualization of the nail seating and screw length. prevent potential screw back-out Color-Coded Locking Instrumentation Color Screw Size

Nailing Advantages Intuitively, there are several advantages to treating a humeral proximal fracture with an intramedullary nail. • Mechanical stability can be accomplished with minimal dissection, allowing rapid mobilization of the patient and early range of motion (ROM) of the shoulder, elbow and wrist joints, thus improving rehabilitation potential. • Periosteal stripping and soft tissue devitalization, compromising revascularization and periosteal callus formation, can also be minimized. • When compared to traditional fixation with a plate, the intramedullary nail and locking screws combination...

Surgical Approach and Fracture Reduction Axillary Nerve Familiarization with techniques to select and expose the correct entry site and nail entry angle as well as the use of the nail as a tool to align the fracture is necessary. It is also crucial to obtain orthogonal x-ray views and avoid destruction of the rotator cuff during implant/instrument insertion. The axillary nerve is the nerve most often damaged during the injury and iatrogenically—even by closed manipulation and percutaneous fixation. During open reduction, the damage occurs especially during soft tissue retraction and percutaneous...

Versanail ® Humeral Proximal Nailing System Entry and Canal Preparation Patient Positioning A bolster can be utilized to elevate the shoulder from the table and to allow shoulder extension (Figure 2). Position the patient supine in the beach chair position on a radiolucent table (Figure 1). To allow easy access to the proximal humerus, it is helpful and recommended to place the C-arm on the opposite side of the table of the injured limb. The C-arm should also be positioned so it is parallel with the head of the patient to allow an axial view of the humeral head. Note: It is not possible to achieve...

Humeral Head Reduction Fracture reduction is accomplished by adducting and extending the proximal fragment with the aid of the joystick while an assistant simultaneously maintains longitudinal traction on the distal arm (Figure 6, right). The humeral head is typically in a varus or valgus position due to contraction of the rotator cuff muscles and the force of impaction during injury (Figure 5, left). Manipulation of the humeral head is accomplished by drilling one or two K-wires lateral to medial in the anterior and posterior portions of the humeral head (Figure 5, right). Using the K-wires,...

Versanail ® Humeral Proximal Nailing System Entry and Canal Preparation Image intensification can be used to place a K-wire through the humeral head in line with the intramedullary axis of the humerus (Figure 7). multaneously using the second joystick to rotate the distal shaft manually to obtain two orthogonal views of the head in reference to the shaft. There are some key considerations to this approach. The first is to use the joysticks to extend and adduct the humeral proximal head, exposing the antero-lateral portion of the head from under the acromion while simultaneously distracting the...

Entry Site and Incision Placement Soft Tissue Protection Make an incision just anterior to the anterior edge of the acromion. The anterior edge may be difficult to palpate and differentiate from the humeral head due to edema and hematoma from the fracture. Therefore, it is helpful to use a K-wire under image intensification to locate the anterior edge of the acromion angle where it intersects the longitudinal axis of the humerus (Figure 9). In cases where the greater tuberosity is intact or non-displaced, a 1 to 1.5 cm incision can be made in the supraspinatus tendon in line with its fibers,...

Versanail ® Humeral Proximal Nailing System Entry and Canal Preparation After the head has been reamed to the desired size, fluoroscopically verify the entry point and advance the awl or entry reamer in line with the humeral canal. The entry reamer is marked to identify the correct reaming depth. A starting point is made with a threaded 3.2 mm x 14 inch guide pin (Cat. No. 14012-14) and a curved cannulated awl (Cat. No. 2810-01-005). Use A-P and lateral fluoroscope views to confirm accurate placement. The entry site in the humeral head is made with the cannulated proximal nail entry reamer (Cat....