Screw Configuration; Proximal Locking: Levels A To D - Synthes MultiLoc Proximal Humeral Nail Technique Manual

Screw Configuration

Proximal locking: Levels A to D

The three 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.
Screw type:
– 4.5 mm Titanium MultiLoc Screws (gold)
The anterior screw (lessor tuberosity, level C) increases the
stability of the construct. It may be used in fractures with a
lesser tuberosity fragment if the fragment is large enough
to accommodate the screwhead. Do not insert a 3.5 mm
locking screw in this location.
Screw type:
– 4.5 mm Titanium MultiLoc Screws (gold)
Additional locking screws (greater tuberosity, levels A, B,
and D) may be inserted through the screwheads of the
lateral screws, to increase stability of the osteosynthesis.
These locking screws are aimed posteriorly where increased
bone density may be present. These additional screws may
be especially useful in osteopenic bone.*
Screw type (optional):
– 3.5 mm Titanium Locking Screws (green)
Ascending screw: Level E
The ascending screw supports the medial calcar region which
can be helpful in medially comminuted fractures.
Screw types:
– 4.0 mm Titanium Locking Screws (blue)
– 4.0 mm Titanium ASLS Screws (brown; optional)
Distal locking: Levels F and G
The two distal locking screws are located in different
planes to reduce implant toggling in the humeral canal,
compared to monoplanar locking.
Screw types:
– 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. Results
showed as much as a 45% increase in construct stability when the secondary
3.5 mm locking screws were assembled with the proximal lateral screws and the
construct was subjected to a static mediolateral bending force. Bench test
results do not necessarily reflect clinical performance.
4 Synthes MultiLoc Proximal Humeral Nail
A
B
C
D
Technique Guide
E
F
G