Expert Humerus Interlocking Nail (Cannulated)
Expert Humerus Interlocking Nail (Cannulated)
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- test ipsilateral distal humerus and elbow for simultaneous mishaps (drifting elbow) record neurovascular assessment (spiral nerve) radiolucent work area with or aside from ipsilateral arm board, pivot sleeping pad 90° patient prostrate with shoulder at part of table c-arm in from foot of sleeping pad with uncover corresponding to bed anterolateral strategy to bear cut 3-4cm close by anterolateral part of acromion, cut up belt and afterward rotator sleeve span begin factor is between bigger tuberosity and sulcus in center of humeral head (half bare region lessen crack the utilization of footing, varus/vagus, and rotational strain used physically use section hatchet or reamer (~8mm) bended along the side then guidewire to stop of humerus begin with aspect 6-7mm reamer, ream 1.5-2.0mm above estimation of extreme nail embed nail over guidewire following parallel curve, zeroed in on data 30° foremost to table, hammer in the utilization of strikeplate, cover nail 7-10mm 3-4 proximal getting screws into humeral head through zeroed in on dance get best circles of distal interlock screws, drill and supplement weight-bearing as endured, real treatment, fluctuate of activity exercises to elbow/wrist/hand, pendulems for shoulder Gear humeral intramedullary nailing framework c-arm fluoroscopy radiolucent table Position patient prostrate with ipsilateral shoulder at feature of sleeping pad with or excepting arm board on the off chance that no armboard utilize right hand to control and keep up with arm tape down and impenetrable head, chest, and mid-region pivot sleeping cushion 90° with the goal that ipsilateral arm is away from Anesthesia prep and wrap total arm into axilla and over average clavicle to ensure adequate working region Or then again Setup and C-arm radiolucent table c-arm in from foot of sleeping cushion with uncover show screen corresponding to bed take primer fluoro AP/Lat of shoulder and humerus to ensure fitting situating throughout the remainder of case can inward/outside pivot arm to get Lat view try not to end reamer in waterway with enormous reamer sizes (dodges reamer head from stalling out) Nail Insertion construct nail on backtable and make specific zeroed in on data follows up with openings in nail, investigate sleeves for each interlock opening fix zenith locking screw with pumpkin screwdriver to lock together embed nail over guidewire, conform to 6° sidelong curve of nail, hammer in with strikeplate focusing on dance should be 30° foremost to sleeping pad for appropriate arrangement hold nail through handle, as of now not the zeroed in on guide, hammer or physically lift to break site, investigate fluoro AP/Lat physically upgrade nail past the break website page to avoid iatrogenic comminution or improvement of new crack strains suitable with utilization of the hammer embed nail absolutely and seat completely, investigate seating in humeral head need to cover nail ~7-10mm to diminish rate of shoulder torment eliminate extensive balltip guidewire Humeral Head Interlocking Screws keep an eye on AP fluoro to see the spot humeral head interlock screws will be found can embed 3-4 (5mm) proximal interlock screws multiplanar screws for appropriate versus left sides mark pores and skin with triple sleeve through dance, utilize 15blade through pores and skin and profound sash place interior sleeves (x2) into guide, push distributions down to bone drill by means of first cortex, fixture second, measure, then, at that point, drill through second cortex embed screw and test size and position on fluoro to make specific no articular entrance on more than one fluoro sees can add endcap into apex of nail to secure in most proximal interlock screw and prevent hard ingrowth into zenith of nail use pumpkin screwdriver to discard locking screw from nail and get rid of oversee and focused on guide Distal Interlocking Screws reevaluate break site and rebate before addition of distal interlock screws if gapping at crack use hand to strike elbow and pack all through break site put arm on mayo stand or pile of towels and cross to distal nail at elbow take AP fluoro for best circles technique for interlocking screws c-arm remains in any case and pivot arm to get best circles (anterolateral course for screws) when distal interlock openings appear as ideal circles, use hemostat manage to limit openings, magazine x2 in with fluoro 10blade through skin, hemostat unfurl down to bone need to imagine bone to stop harm to encompassing nerves spiral nerve can be broken with sidelong to average interlock screws, musculocutaneous nerve with front to back screws place drill through opening, then, at that point, make drill opposite to C-arm pillar and drill through first cortex and nail stop at second cortex, measure (add 5mm to estimate to add second cortex thickness), and afterward drill second cortex while all things considered in ideal circles lat fluoro, entire second distal interlock screw and measure c-arm to AP capacity to move, embed each interlock screws Affirm Nail Position and Extremity Check take shutting AP/Lat of distal and proximal variables of nail and crack really take a look at appendage length, revolution, and arrangement Conclusion Water system and Hemostasis unequivocally flush out nail addition site page and interlocking screw sites with saline bulb water system close up fringe draining vessels Rotator Interval and Fascia Closure close rotator sleeve and sash with 0-vicryl or 2-0 Ethibond stitches subcutaneous and pores and skin conclusion with 2-0 vicryl and staples Dressing delicate entry point dressings over shoulder and proximal/distal interlock cuts.
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