Versanail Humeral Proximal Nailing System

Loading...

Taking too long?

Reload document

| Open in new tab

Versanail® Humeral Proximal
Nailing System

Product Rationale & Surgical Technique

Versanail® Humeral Proximal Nailing System

Contents

Design Summary ………………………………………………………………………………………………………………………………………. 3

Implant Overview………………………………………………………………………………………………………………………………………. 6

Precautions ……………………………………………………………………………………………………………………………………………… 7

Entry and Canal Preparation ………………………………………………………………………………………………………………………. 8

Nail Insertion ………………………………………………………………………………………………………………………………………….. 14

Proximal Locking …………………………………………………………………………………………………………………………………….. 16

Distal Locking …………………………………………………………………………………………………………………………………………. 19

End Cap Placement ………………………………………………………………………………………………………………………………… 20

Nail Removal ………………………………………………………………………………………………………………………………………….. 22

Ordering Information ……………………………………………………………………………………………………………………………….. 23

Note: This brochure presents a surgical technique available for use with the Biomet, Inc., VersaNail® Platform instru-
ments 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

• Mechanical stability achieved with minimal

dissection, for rapid postoperative mobilization

• Proprietary locking sleeve system reduces

potential for proximal screw back-out

• Easy-to-use targeting jig rotates for simplified
screw placement and improved visualization

• The intuitive, universal instrumentation system

enables efficiency in the OR

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 technol-
ogy 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, reducing the likelihood of
back-out. The VersaNail® Platform instrumentation system
is designed for intuitive assembly and ease-of-use by OR
staff and surgeons, enabling a simpler and more efficient
procedure. The instrumentation is designed to provide
intra-operative options including entry portals, reduction
tools and color-coded screw placement, while being stan-
dardized to maintain commonality across the platform.

3

Versanail® Humeral Proximal Nailing System

The Humeral Proximal Nail is designed to treat proximal
humeral fractures.

Top View

Proximal Screws:
• Unique proximal screw configuration

enhances fragment fixation
• 4.8 mm cancellous screws
• 2 L-M transverse screws: 30 degrees

• 1 L-M oblique screw: 45 degrees for

from oblique screw

provisional fixation

3.0 mm cannulation accepts
guide wire during nail insertion

Sizes: 8 mm and 10 mm diameter
Length: 150 mm

Distal Screws:
• 3.5 mm for 8 mm nail
• 4.5 mm for 10 mm nail

4

Locking sleeve and end cap
prevent potential screw back-out

11.35 mm

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.

0 mm

13 mm

20 mm

35 mm

105 mm

60 mm

45º

0 mm

8 mm / 10 mm

Color-Coded Locking Instrumentation

Color

Screw Size

Drill Bit Size

Green Dot

4.8 mm Cancellous

Green Dot

4.5 mm Cortical

Blue Dot

3.5 mm Cortical

3.8 mm

3.8 mm

2.9 mm

5

Versanail® Humeral Proximal Nailing System

Implant Overview

Nailing Advantages

Nailing Pitfalls

Intuitively, there are several advantages to treating a hu-
meral 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 decreases the amount of hardware
susceptible to soft tissue irritation or impingement.

Additionally, the centrally placed intramedullary nail func-
tions as an additional point of fixation for the humeral
head, increasing the stability of the fracture complex. Such
a construct reduces dependence on the screw to bone
interfaces, which may be unreliable in osteo-porotic bone
treated with screws and plates.

Locked intramedullary nailing also has the potential to avoid
problems, such as screw backout, impingement and loss
of fixation inherent in the use of thin flexible rods or pins for
humeral proximal fixation. Although application of intramed-
ullary rods for humeral proximal fractures can overcome
many problems associated with other fixation methods, it
needs to be done carefully to avoid its own inherent pitfalls.

Nail application in humeral proximal fractures has some-
times resulted in fixation constructs where the nail has a
loose proximal fit resulting in increased dependence on
locking screws for stability. Such methods are in sharp con-
trast to diaphyseal nailing in which endosteal cortical con-
tact between the nail and the fragment is generally sufficient
to accomplish alignment reduction and maintenance. The
complications encountered when nailing humeral proximal
fractures can be classified into the following categories:

• Implant design
• Surgical approach
• Reduction and anatomic alignment
• Nail insertion technique
• Skeletal anatomy

Implant Design

The fixation obtained in the proximal fragment is depen-
dent upon nail contact with the subchondral bone of the
humeral head at the entry site and one or two interlocking
screws. Deforming forces during fracture healing stress the
bone-fracture interface and may result in loss of alignment
if fixation is dependent on the screw purchase alone. The
shape of the implant also dictates the entry point. Implants
with a pronounced lateral proximal bend require an entry
point that potentially damages the insertion of the rotator
cuff and makes alignment of the proximal fragments with
the shaft more difficult.

A pronounced lateral bend also requires over-reaming of
the entry site, decreasing contact between the top of the
nail and the subchondral bone of the head. Most implant
designs also do not have the ability to lock the proximal
screw to the nail, resulting in a high incidence of screw mi-
gration. Thus, an implant with a relatively straight proximal
section and the ability to accept proximal locking screws
that can be placed both above and below the fracture line
is important to help maintain if adequate control of the
proximal fracture fragments. The resulting complications
from a selection of implants with inappropriate designs
for treatment of humeral proximal fractures are specific to
the particular design of the implant. These include cutout,
loss of alignment, loss of fixation, hardware impingement
and rotator cuff pain.

6