Surgical technique and apparatus for proximal humeral fracture repair

Abstract

A method and apparatus of reattaching a bone fragment to a proximal humerus of a humerus in a shoulder joint. The method includes introducing a distal end of the humeral nail into a medullary canal of the humerus. A first proximal screw is engaged with the bone fragment and a first proximal bore in the proximal end of the humeral nail to move the bone fragment toward the proximal humerus. The humeral nail and the attached bone fragment are rotated relative to the medullary canal of the humerus to position the bone fragment to an anatomically optimal location. The bone fragment is preferably one of a greater or lesser tuberosity of the proximal humerus. The method and apparatus can be used to reattach bone fragments in a variety of other joints.

1 . A method of reattaching a bone fragment separated from a proximal humerus of a humerus in a shoulder joint, the method comprising the steps of:
 introducing a distal end of the humeral nail into a medullary canal of the humerus;   engaging a first proximal screw with the bone fragment and a first proximal bore in the proximal end of the humeral nail to fix the attach the bone fragment to the nail; and   rotating the humeral nail and the attached bone fragment relative to the medullary canal of the humerus to position the bone fragment to an anatomically optimal location.   
     
     
         2 . The method of  claim 1 , further comprising the step of rotationally orienting the humeral nail relative to the bone fragment before engaging the first proximal screw. 
     
     
         3 . The method of  claim 1 , further comprising the step of using an aiming device to locate the first proximal screw relative to the humeral nail. 
     
     
         4 . The method of  claim 1 , further comprising the step of attaching an aiming device to a proximal end of the humeral nail. 
     
     
         5 . The method of  claim 1 , further comprising the step of advancing the first proximal screw in the first proximal bore so that a distal end of the first proximal screw does not substantially extend past the humeral nail. 
     
     
         6 . The method of  claim 1 , further comprising the step of engaging a second proximal screw with the proximal humerus and a second proximal bore in the proximal end of the humeral nail. 
     
     
         7 . The method of  claim 1 , wherein the humeral nail and first proximal screw are implanted percutaneously. 
     
     
         8 . The method of  claim 1 , further comprising the step of engaging a plurality of proximal screws with the proximal humerus and a plurality of proximal bores in the proximal end of the humeral nail. 
     
     
         9 . The method of  claim 1 , further comprising the step of engaging at least one distal screw with the humerus and a distal bore in the distal end of the humeral nail. 
     
     
         10 . The method of  claim 1 , wherein engaging the first proximal screw comprises engaging the first proximal screw with a greater tuberosity of the proximal humerus, into the proximal humerus, and into the first proximal bore in the proximal end of the humeral nail. 
     
     
         11 . The method of  claim 1 , wherein engaging the first proximal screw comprises engaging the first proximal screw with a lesser tuberosity of the proximal humerus, into the proximal humerus, and into the first proximal bore in the proximal end of the humeral nail. 
     
     
         12 . The method of  claim 1 , further comprising the step of engaging another proximal screw with a proximal humeral and a proximal bore in the proximal end of the humeral nail, the other proximal screw being located about 30 degrees to about 40 degrees relative to a neutral axis. 
     
     
         13 . The method of  claim 1 , further comprising the step of engaging another proximal screw with a proximal humeral and a proximal bore in the proximal end of the humeral nail, the other proximal screw being located about 90 degrees to about 100 degrees relative to a neutral axis. 
     
     
         14 . The method of  claim 1 , wherein the first proximal screw is located about 50 degrees to about 60 degrees relative to a neutral axis. 
     
     
         15 . The method of  claim 1 , wherein rotating the humeral nail and the attached bone fragment within the medullary canal of the humerus comprises rotating the humeral nail and the attached bone fragment about zero degrees to about 40 degrees before a second proximal screw is engaged with the humeral nail. 
     
     
         16 . The method of  claim 1 , wherein a humeral head of the proximal humerus is retained medially by the glenoid, anteriorly and posteriorly by the rotator cuff muscles and the tuberosities, and superiorly by the humeral nail. 
     
     
         17 . The method of  claim 1 , wherein a humeral head of the proximal humerus is retained to the proximal humerus solely with anatomical features of the shoulder joint. 
     
     
         18 . The method of  claim 1 , wherein the humeral nail comprises a substantially linear shaft. 
     
     
         19 . The method of  claim 1 , wherein the angular offset and relative position of the proximal screw facilitates insertion of the screw at the insertion muscle location, where the screws are retained by substantially solid bone and the muscle. 
     
     
         20 . A humeral nail comprising:
 a substantially linear elongate shaft having a proximal portion, a distal portion, and a central axis and configured to define a neutral axis with respect to the central axis;   at least one distal bore at the distal portion of the elongate shaft having a distal bore axis;   a first proximal bore at the proximal portion of the elongate shaft positioned between about 50 degrees and about 60 degrees relative to a neutral axis in a postero-anterior direction;   a second proximal bore at the proximal portion of the elongate shaft positioned between about 30 degrees and about 40 degrees relative to the neutral axis in a postero-anterior direction;   a third proximal bore at the proximal portion of the elongate shaft positioned between about 90 degrees and about 100 degrees relative to the neutral axis in an antero-posterior direction;   a first distal screw for engagement with the first distal bore;   a first proximal screw for engagement with the first proximal bore;   a second proximal screw for engagement with the second proximal bore; and   a third proximal screw for engagement with the third proximal bore, wherein the first proximal screw has a length shorter than a length of the second and third proximal screws.   
     
     
         21 . The humeral nail of  claim 20 , wherein both the second and third proximal bores are positioned on one side of the first proximal bore along the elongate shaft. 
     
     
         22 . The humeral nail of  claim 20 , further comprising a fourth proximal bore at the proximal portion of the elongate shaft positioned between about 20 and about 40 degrees relative to the neutral axis in an antero-posterior direction. 
     
     
         23 . The humeral nail of  claim 22 , wherein both the second and third proximal bores are positioned on one side of the first proximal bore along the elongate shaft, whereas the fourth proximal bore is positioned on the opposite side of the first proximal bore. 
     
     
         24 . The humeral nail of  claim 22 , further comprising a fourth proximal screw for engagement with the fourth proximal bore, wherein the length of the first proximal screw is shorter than a length of the fourth proximal screw. 
     
     
         25 . The humeral nail of  claim 20 , wherein the distal bore axis of the at least one distal bore is substantially parallel to the neutral axis. 
     
     
         26 . The humeral nail of  claim 20 , wherein the distal bore axis of the at least one distal bore is at an angle of between about 15 degrees and about 25 degrees relative to the neutral axis in an antero-posterior direction. 
     
     
         27 . The humeral nail of  claim 20 , wherein at least two distal bores are provided at the distal portion of the elongate shaft. 
     
     
         28 . The humeral nail of  claim 20 , wherein at least one of the first, second, third and fourth proximal screws includes a head portion and a body portion, wherein the head portion has a diameter that is about two times greater than a diameter of the body portion, and further wherein the head portion has a substantially flat surface that is connected to the body portion.