{"product_id":"proximal-humerus-case-04-intramedullary-nail","title":"PROXIMAL HUMERUS [CASE 04] - Intramedullary Nail","description":"\u003cp\u003eThis orthopedic trauma learning case reviews the surgical reasoning behind osteosynthesis of a proximal humerus fracture using a modern intramedullary nail. The case highlights preoperative interpretation of fracture morphology, including recognition of greater tuberosity fragmentation on computed tomography, and explains why intramedullary fixation was selected based on the presence of a substantial humeral head fragment.\u003c\/p\u003e\n\u003cp\u003eThe procedural discussion focuses on patient positioning in the beach-chair position, intraoperative fluoroscopic assessment, and percutaneous reduction strategies using a Kirschner wire as a joystick. The instructor demonstrates how manipulation of the arm and joystick can help address posterior rotation, impaction, valgus alignment, and rotational control of the proximal fragment.\u003c\/p\u003e\n\u003cp\u003eA central teaching point is the importance of the nail entry point. The case explains how a more centralized and medial entry point in newer-generation humeral nails may help align the implant with the intramedullary axis while reducing unnecessary conflict with the greater tuberosity and rotator cuff region. The learner is guided through the rationale for confirming the entry point in both anteroposterior and lateral fluoroscopic views before advancing the guidewire and nail.\u003c\/p\u003e\n\u003cp\u003eThe case also covers implant insertion principles, avoidance of forceful hammering, screw placement in the humeral head and calcar region, percutaneous locking technique, assessment of nail prominence, and systematic fluoroscopic rotation to evaluate screw position and avoid intra-articular placement. The instructor concludes with a reflective critique of a mild residual obliquity seen on lateral imaging, using it as a practical learning point about guidewire trajectory and reduction accuracy.\u003c\/p\u003e\n\u003ch2\u003e\u003cstrong\u003eINCLUDED CONTENT\u003c\/strong\u003e\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eCase-based procedural walkthrough\u003c\/li\u003e\n\u003cli\u003ePreoperative fracture assessment discussion\u003c\/li\u003e\n\u003cli\u003eBeach-chair positioning overview\u003c\/li\u003e\n\u003cli\u003ePercutaneous reduction strategy using a joystick wire\u003c\/li\u003e\n\u003cli\u003eGuidewire and nail entry point planning\u003c\/li\u003e\n\u003cli\u003eFluoroscopic assessment in anteroposterior and lateral views\u003c\/li\u003e\n\u003cli\u003eIntramedullary nail insertion principles\u003c\/li\u003e\n\u003cli\u003eProximal humeral head and calcar screw placement discussion\u003c\/li\u003e\n\u003cli\u003eDistal antirotational locking screw placement overview\u003c\/li\u003e\n\u003cli\u003eFinal imaging review and technical self-assessment\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2\u003e\u003cstrong\u003eTARGET AUDIENCE\u003c\/strong\u003e\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eOrthopedic trauma surgeons\u003c\/li\u003e\n\u003cli\u003eOrthopedic surgery residents and fellows\u003c\/li\u003e\n\u003cli\u003eShoulder and upper-limb surgeons\u003c\/li\u003e\n\u003cli\u003eTrauma fellows\u003c\/li\u003e\n\u003cli\u003eMedical educators teaching fracture fixation principles\u003c\/li\u003e\n\u003cli\u003eOperating room professionals involved in orthopedic trauma procedures\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2\u003e\u003cstrong\u003eEDUCATIONAL NOTICE\u003c\/strong\u003e\u003c\/h2\u003e\n\u003cp\u003eThis content is intended for medical education and procedural learning only. It does not replace formal surgical training, institutional protocols, clinical judgment, or supervision by qualified professionals. Surgical decisions must be individualized and reviewed by appropriately trained clinicians. Human expert review is mandatory before any educational or clinical use.\u003c\/p\u003e\n\u003cp\u003e\u003c!-- notionvc: 1be7103d-7955-4763-b1d5-2cdea56a02d7 --\u003e\u003c\/p\u003e","brand":"Dr Savio Chami","offers":[{"title":"Default Title","offer_id":43856113860669,"sku":null,"price":0.0,"currency_code":"BRL","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0641\/3664\/2621\/files\/RO_EN_result.webp?v=1792504058","url":"https:\/\/surgie.com\/es\/products\/proximal-humerus-case-04-intramedullary-nail","provider":"Surgie","version":"1.0","type":"link"}