Synthes MultiLoc Proximal Humeral Nail Technique Manual

Synthes MultiLoc Proximal Humeral Nail Technique Manual

Proximal humeral nail with multiple locking options for simple and fractures
Table of Contents

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Proximal humeral nail with multiple
locking options for simple and complex
fractures.
Technique Guide

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Table of Contents
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Summary of Contents for Synthes 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 3 Table of Contents Introduction MultiLoc Proximal Humeral Nail Screw Configuration AO Principles Indications Clinical Cases Surgical Technique Patient Positioning Approach Opening the Humerus Nail Insertion Nail Positioning Proximal Locking MultiLoc Screws 3.5 mm Locking Screws Distal Locking End Cap Insertion...
  • Page 4 MultiLoc Proximal Humeral Nail. Proximal humeral nail with multiple locking options for simple and complex fractures. MultiLoc Screws 1 Blunt screw tips to minimize the risks associated with secondary screw perforation 2 Countersunk screwheads to reduce implant prominence 3 Four suture holes per screw, for attachment of the rotator cuff muscles 4 Option for secondary 3.5 mm locking...
  • Page 5 Angular Stable Locking System ASLS (optional) Improved fixation in poor bone quality. * Comparative testing was conducted by Synthes secondary 3.5 mm locking screws were assembled with the MultiLoc Humeral Nail construct with the proximal LM screws and the construct...
  • Page 6 – 4.0 mm Titanium Locking Screws (blue) – 4.0 mm Titanium ASLS Screws (brown; optional) * Comparative testing conducted by Synthes with the MultiLoc Proximal Humeral Nail construct implanted in polyurethane foam block material of multiple densities. Testing compared the stability of the nail construct with and without secondary 3.5 mm locking screws assembled with the proximal lateral screws.
  • Page 7 Early, active mobilization Early and safe active mobilization of the part and patient. 1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger. Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 8 Indications The MultiLoc Proximal Humeral Nail is indicated for fractures of the proximal humerus, including: – 2-part surgical neck fractures – 3-part fractures – 4-part fractures Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 9 – Standard distal locking Preoperative, AP view Postoperative, AP view Preoperative, scapular Y-view Postoperative lateral view *Results from case studies are not predictive of results in other cases. Results in other cases may vary. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 10 – 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 Preoperative, AP view Postoperative, AP view Preoperative, scapular Y-view Postoperative lateral view Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 11 – 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 Preoperative, AP view Preoperative, scapular Y-view Preoperative, 3-D CT reconstruction Postoperative lateral view MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 12 C-arm opposite the surgeon, perpendicular to the longitudinal axis of the humeral shaft in the AP view. Obtain a scapular “Y” lateral view by bringing the C-arm through a 90° arc and projecting the beam directly at the glenoid. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 13 The nerve may be identified by gentle palpation or careful dissection. A stay suture may be placed, to prevent further extension of the Deltoid muscle incision. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 14 If necessary, use Kirschner wires to hold the fragments tem- porarily in place during insertion of the implant. Ensure that the Kirschner wires do not block insertion of the nail. Check the reduction under imaging. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 15 Note: If the acromion inhibits access to the ideal entry point, extend the shoulder to move the apex of the humeral head in front of the acromion. Entry point Long biceps tendon Sulcus Lesser tuberosity Greater tuberosity MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 16 2.5 mm Kirschner Wire, trocar point, 285 mm If the cannulated awl is preferred for opening the medullary canal, insert a 2.5 mm Kirschner wire instead of the guide rod. Continue with Step 3, Option B. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 17 Remove the hollow 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 drill bit.
  • Page 18 Secure the assembly with the combination wrench. Note: The anatomic design of the MultiLoc Proximal Humeral Nail requires right and left versions. Nails are labeled “RIGHT” or “LEFT”. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 19 – If nail insertion is difficult, choose a smaller diameter nail or ream the intramedullary canal to a larger diameter. – Pressure against the elbow when advancing the nail prevents distraction and potential healing problems. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 20 Aiming Arm, anterior, for MultiLoc Proximal Humeral Nail 03.019.031 Aiming Arm Knob If the anterior screw (lesser tuberosity) or the ascending screw will be used, connect the anterior aiming arm to the insertion handle and tighten the knob. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 21 Caution: The proximal nail end should be at least 2 to 3 mm below the cartilage to minimize the risk of impingement while maximizing stability. Check the proximal nail position clinically and under imaging. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 22 Push one trocar down to the bone. Remove the trocar. Note: The holes for the MultiLoc screws are marked with an orange circle. Technique tip: For temporary fixation, remove one of the trocars and insert a 2.5 mm Kirschner wire. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 23 Slightly rotate the nail if needed. Note: Ensure that the lesser tuberosity is large enough to accommodate a MultiLoc screw. If not, consider other means of fixation, such as smaller independent screws or osteosuturing. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 24 Read the screw length directly from the depth probe at the back of the outer sleeve. Note: The orange marking on the depth probe will align with the outer opening of the protection sleeve. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 25 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 countersink the MultiLoc screw. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 26 Note: Properly countersink the most proximal screws to avoid risk of impingement. To allow suture fixation, do not overinsert the screw, (see page 36). Use the orange marking on the shaft of the screwdriver as an indicator of screw insertion depth. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 27 Remove the anterior aiming arm, if used. Note: The 3 lateral screws (greater tuberosity, levels A, B, and D) must be used in any fracture situation as they ensure the basic stability of the construct. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 28 Ensure the two handles of the drill sleeve are exactly perpendicular to the nail. Rotate the assembly, if necessary. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 29 Monitor under imaging. Read the screw length on the fenestrated scale of the depth probe. Remove the drill sleeve. Note: Do not change the position of the centering sleeve. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 30 Remove the centering sleeve. Caution: Always use a torque limiting attachment when inserting the 3.5 mm locking screws. Note: The centering sleeve can only be removed when the 3.5 mm locking screw is fully seated. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 31 Reassemble the lateral aiming arm to the insertion handle and tighten the knob. Note: Ensure the aiming arm shows “RIGHT” when used for the right humerus and “LEFT” when used for the left humerus. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 32 Note: The holes in the aiming arm for distal locking screws and the ascending screw are marked with a blue circle. Technique tip: Two distinct skin incisions are recommended when inserting the two distal locking screws. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 33 Insert the calibrated drill bit and drill carefully until the level of the subchondral bone is reached. Confirm drill bit position under imaging. Caution: Do not penetrate the articular surface. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 34 Read the screw length directly off the depth gauge. Note: The blue mark on the depth gauge will align with the outer opening of the protection sleeve. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 35 Insert remaining 4.0 mm locking screws To insert the second distal 4.0 mm locking screw, repeat Steps 1 through 3. To insert the ascending screw, follow the same procedure. Remove the lateral aiming arm. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 36 If removal of the connecting screw is difficult, use the combination wrench. Note: The proximal nail end and end cap should be 2 to 3 mm below the cartilage, to minimize the risk of impingement while providing maximum stability. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 37 – The grooves on the insertion handle help to identify the insertion depth under imaging. – The proximal nail end and end cap should be 2 to 3 mm below the cartilage, to minimize the risk of impingement while providing maximum stability. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 38 Place one or more heavy, nonabsorbable sutures in the region of the tendinous insertion of the supraspinatus, infraspinatus, and subscapularis muscles. Attach the sutures to the MultiLoc Screw using the suture holes provided. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 39 Remove 3.5 mm locking screws Instruments 03.019.005 Handle with Quick Coupling, 150 mm 314.116 StarDrive Screwdriver Shaft, T15, quick coupling Assemble the screwdriver shaft and handle and remove all 3.5 mm locking screws. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 40 Screwdriver StarDrive, T25, with coupling for 03.019.019, 330 mm Remove all 4.0 mm locking screws with the T25 StarDrive screwdriver. Note: Ensure the extraction screw is connected to the nail before removing the last locking screw. Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 41 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 gentle hammer blows to extract the nail. MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 42 – 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, left 04.016.038S 9.5 mm, right 04.016.039S 9.5 mm, left Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 43 04.019.042 04.019.022 04.019.044 04.019.024 04.019.046 04.019.026 04.019.048 04.019.028 04.019.050 04.019.030 04.019.052 04.019.032 04.019.054 04.019.034 04.019.056 04.019.036 04.019.058 04.019.038 04.019.060 04.019.040 Available nonsterile or sterile-packed. Add “S” to product number for sterile product. ◊ MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 44 – Self-tapping Length Length (mm) (mm) 412.109 412.117 412.110 412.118 412.111 412.134 412.112 412.136 412.113 412.120 412.115 412.121 412.116 412.122 Available nonsterile or sterile-packed. Add “S” to product number for sterile product. ◊ Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 45 04.005.444 04.005.416 04.005.446 04.005.418 04.005.448 04.005.420 04.005.450 04.005.422 04.005.452 04.005.424 04.005.454 04.005.426 04.005.456 04.005.428 04.005.458 04.005.430 04.005.460 04.005.432 04.005.434 04.005.436 Available nonsterile or sterile-packed. Add “S” to product number for sterile product. ◊ MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 46 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 recess Extension (mm) 04.019.000S 04.019.002S 04.019.005S 04.019.010S 04.019.015S Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 47 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 03.019.004 11.5 mm Hollow Drill Bit, for 9.5 mm MultiLoc Proximal Humeral Nail MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 48 Instruments 03.019.005 Handle with Quick Coupling, 150 mm 03.019.006 Insertion Handle for MultiLoc Proximal Humeral Nail 03.019.007 Connecting Screw, cannulated, for MultiLoc Humeral Nail 03.019.008 Aiming Arm, lateral, for MultiLoc Proximal Humeral Nail Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 49 13.0 mm/10.0 mm Protection Sleeve, for 4.5 mm Titanium MultiLoc Screws, 150 mm 03.019.014 10.0 mm/3.8 mm Drill Sleeve, for 03.019.013 03.019.015 3.8 mm Trocar, for 03.019.014 03.019.016 3.8 mm Three-Fluted Drill Bit, quick coupling, calibrated, 270 mm MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 50 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 03.019.019 03.019.023 End Cap Ruler, for MultiLoc Humeral Nailing System Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 51 Screwdriver 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 Combined Hammer, 360 grams MultiLoc Proximal Humeral Nail Technique Guide Synthes...
  • Page 52 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 319.97 Screw Forceps Synthes MultiLoc Proximal Humeral Nail Technique Guide...
  • Page 53 321.16 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 Synthes...
  • Page 54 10.0 mm Hollow Drill Bit for MultiLoc Humeral Nailing System, sterile 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 03.019.018S 6.5 mm Drill Bit, conical, with stop, sterile...
  • Page 55 Nailing System, for 03.019.008 and 03.010.405 03.019.031 Aiming Arm Knob for MultiLoc Humeral Nailing System, for 03.019.009 310.288 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...
  • Page 56 03.019.019, length 330 mm and_Sterilization.aspx or to the below listed inserts, which will be included in the shipping container: – Processing Synthes Reusable Medical Devices — Instruments, Instrument Trays and Graphic Cases — DJ1305 – Processing Non-sterile Synthes Implants — DJ1304...
  • Page 57 314.116 StarDrive Screwdriver Shaft, T15, self-retaining, quick coupling 319.97 Screw Forceps 321.16 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 Synthes...
  • Page 58 MultiLoc Proximal Humeral Nail Implant Set (01.019.005) Screw Rack 60.019.004 Screw Rack for MultiLoc Humeral Nailing System Implants 4.0 mm Titanium Locking Screw, with T25 StarDrive recess, for IM Nails, sterile, 2 ea. 04.005.408S 18 mm 04.005.410S 20 mm 04.005.412S 22 mm 04.005.414S...
  • Page 59 Titanium MultiLoc Proximal Humeral Nail, 3.5 mm Titanium Locking Screw, cannulated, 160 mm, sterile self-tapping, with StarDrive recess, sterile, 2 ea. 04.016.034S 8 mm, right 412.109S 26 mm 04.016.035S 8 mm, left 412.110S 28 mm 04.016.038S 9.5 mm, right 412.111S 30 mm 04.016.039S...
  • Page 60 To order: (800) 523-0322 To order: (800) 668-1119 Fax: (610) 251-9056 Fax: (905) 567-3185 www.synthes.com © 2011 Synthes, Inc. or its affiliates. All rights reserved. MultiLoc and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 7/11 J9981-A...

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