Evolution - FH Orthopedics

TIPS AND TRICKS
Point of entry
>> Point of entry and nail length.
The nail must penetrate the articular surface
at the top of the humeral head. Its proximal
extremity must be situated below the bone
level of the humeral head.
>> Crucifiction
In complex fractures, this consists of pinning the humeral head, which has been reduced in its
anatomical position, on to the glenoid. This then makes it possible to descend the nail, resulting in
osteosynthesis of the tuberosities. This technique can replace the ball-and-socket technique.
TELEGRAPH
®
>> Distal locking of the long TELEGRAPH ®
◊ © FH ORTHOPEDICS Communication - ms_mtel08_av1uk
With the automatic instrumentation, the
inclined observation tube (red arrow, left) of
the image intensifier makes it possible to
verify the correct mediolateral level of the
drilling (right image).
For more informations, please contact us.
FH ORTHOPEDICS S.A.S
3 rue de la Forêt - F 68990 HEIMSBRUNN
Tél. +33 3 89 81 90 92 / Fax : +33 3 89 81 80 11
e-mail : [email protected]
www.fhorthopedics.fr
POLSKA, IMPLANTS INDUSTRIE
Oddzial w Polsce 60-171
Poznań, ul. Paczkowska 26
Tel : +48 61 863 81 27 / Fax : +48 61 863 81 28
e-mail : [email protected]
USA, FH ORTHOPEDICS INC.
909 Third Avenue, Suite 500
New York, New York 10022
Tel : +1 646 495 3112 / Fax : +1 646 495 3113
e-mail : [email protected]
Evolution
www.telegraphnail.com
Dear Colleagues,
After 8 years, 25,000 TELEGRAPH® nails have been implanted
worldwide.
TELEGRAPH® was the first to propose the principle of screw self‑stability
in a nail. This nail is the most commonly implanted in France and its
principles were soon copied by all the major companies in the field.
These are all signs of success for both the technique and the quality of the
implants and their instrumentation.
March 2008
Dr Christian CUNY
THE UNDENIABLE ADVANTAGES
NEW INSTRUMENTATION : MIXED
This instrument makes it possible to implant both short and long nails.
A few parts adapted to the short instrument make it possible to do the
distal locking of the long TELEGRAPH® in both the anteroposterior and
posteroanterior positions.
>> Limited space requirement
>> A scientific environment
The TELEGRAPH® nail remains the least obstructive
material available for anterograde nailing of the
humerus, be it for proximal or diaphyseal fractures. This
limited obstruction plus the straightness of the nail are
the explanation for the absence of lesions at the level of
the rotator cuffs.
It is rare for a technique to have so rapidly provoked
such a high level of scientific interest. At present, we
can count a very high number of communications
and publications. They originate from both the design
centre and other centres.
>> Indications
This nail has become relatively "must-have" for two
or three fragment extra-articular fractures (more than
60% of cases), particularly with the percutaneous
technique.
Articular valgus impacted fractures are a very standard
indication and are operated on by means of an equally
standard technique. Three or four fragment disimpacted,
or even dislocated, fractures remain indications that need
discussing in relation to the implantation of a shoulder
prosthesis.
The new version of the screws, like the new definition of
self-stability, make it possible to develop the product's
use in complex indications.
NEW SCREWS
Today, new screws are proposed for proximal locking of the TELEGRAPH®.
These screws retain their low obstruction qualities, making possible
osteosynthesis of complex fractures, but have been strengthened in
their central volume bore and in terms of the material from which they
are made. These new screws have greater resistance to torsion and
flexion than previous versions. No fractures have been reported with
these screws.
THE SELF-STABILITY CONCEPT REDEFINED
In previous versions, the stability of the proximal screws within the nail,
which is responsible for preventing swaying and migration into the
openings, was damaged. This modification to the self-stability qualities,
in addition to the relative weakness of the previous screws, broadly
explains the disappointing results reported by certain teams on the
subject of complex fractures. These new TM30 screws, with the latest
versions of the self-stability system in the nail, guarantee total absence
of movement of the screws and thus perfect stability of the assemblies.
Average torque following rupture in
torsion of different screws, cancellous
type, diameter 4. Tests carried out at
the CRITT.
Stainless steel 316 RSV
screw: 1.36 N.m
M30 NW screw: 2.64 N.m
Max. diametral range between
screw and first generation nail :
Four doctoral theses have been written on the subject.
Three publications in particular are currently in press:
one on the short TELEGRAPH® at four years, one on the
long, and finally one that will soon propose a simpler and
more reproducible classification system for fractures of
the proximal humerus. This system is called AST.
These studies were made possible in particular thanks to
the participation of FH ORTHOPEDICS' André Hermann
evaluation centre.
www.ceah.org
>> Percutaneous implantation
This is the technique currently used in more than 50 % of cases. Percutaneous
implantation is particularly simple with 2 and 3 fragment extra-articular
fractures.
>> Dynamic distal locking
One of the first evolutions in this nail was to propose an oblong distal opening
for dynamic locking. This has become almost systematic in our practice. It
makes it possible to compress the fracture site and thus avoid any risk of
migration and rupture of the proximal screws.
0,3 mm
Max. diametral range between
screw and second generation nail :
0,1 mm
>> The long TELEGRAPH® for diaphyseal fractures
One of its particularities is its small diameter (7 mm for the smallest model)
and its assisted original distal locking. This locking can here also (and should
in our opinion) be dynamic.