Turon Product Brochure

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Product Guide

Turon™ Modular Shoulder System

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TM

INTERNAL USE ONLY

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2

Humeral Head Trialing

• WhentrialingwiththeAngledNeckTrialin

combinationwithanOsetHumeralHead

Trial,besuretonotethepositionofthe

AngledNeckTrialandtheOsetHumeral

HeadTrialrelativetotheosteotomysurface.

• Itisrecommendedtodialinandrecordthe

desiredpositionoftheAngledNeckTrialprior

torecordingthedeterminedpositionofthe

OsetHumeralHeadTrial.

• Ifpreferred,humeralheadtrialingmaybe

performedothenalstem.Afterglenoid

implantation,thesurgeonmaydesireto

proceedimmediatelytonalhumeralstem

implantationandperformhumeralhead

trialingothenalstem.

• ForinstanceswhentheTrialNecksare

diculttoremove,theHumeralNeck

Extractorcanbeused.

HumeralHeadOsteotomy

• Awelldonehumeralosteotomyrequiresthat

thesurgeonmaketheosteotomycutatorvery

nearthepatient’sanatomicneckandavoids

anaggressivecutwhichcoulddestabilizethe

rotatorcu.

• Failuretoremovetheposteriorosteophytescan

resultinadicultglenoidexposure.

GlenoidFaceplatePreparation

• TheGlenoidDrillGuideHandle(804-25-040)has

aspring-loadedthreadedtip.Toensureproper

assembly,the“spring-loaded”tipmustbeush

againsttheGlenoidSizing/DrillGuide,38mm–

54mm(804-25-101_105)priortoengagingthe

threads.Thespring-loadedtipisdesignedtohelp

preventcross-threadingandsecureatightt.

• Correctionofglenoidversionshouldrarely

exceed10degreesasthiscouldcompromise

bonestock.Ifgreaterdegreesofcorrectionare

necessary,itmaybeprudenttouseakeeled

component.

PeggedGlenoidTechnique

• Theinferiorpegsofthe38mmPeggedGlenoid

(520-01-238)areshorterthantotheother

PeggedGlenoidsizes.Thisiswhythereisa

separate38mmPegDrillGuide(804-25-124).

• Ensurethe5.0mmStopDrill(804-25-147)isin

proper“in-line”alignmentwiththeGlenoidDrill

Guidesandfreefromanysofttissueinterference.

Improperalignmentcanleadtostrippingand/or

bindingofthedrillagainstthedrillguide.

Head/Neck/Stem Interferences

Depending upon whether a

Straight or an Angled Neck

is used, there are certain

humeral head and stem

configurations that are not

compatible and may cause

head/stem interferences. A

listing of these head/stem

interferences is provided to

the right.

Stem Straight Neck Angled Neck

Size6 38mmx18mmOffset

HumeralHead

Size8 38mmx18mmOffset

HumeralHead

Size10 38mmx18mmOffset

HumeralHead

Size12 38mmx18mmOffset

HumeralHead

38mmx18mmOffset

HumeralHead

42mmx16mmOffset

HumeralHead

Size14

38mmx18mmOffset

HumeralHead

42mmx16mmOffset

HumeralHead

38mmx18mmOffset

HumeralHead

42mmx16mmOffset

HumeralHead

Size16

38mmx18mmOffset

HumeralHead

42mmx16mmOffset

HumeralHead

42mmx20mmOffset

HumeralHead

46mmx16mmOffset

HumeralHead

38mmx14mmNeutral

HumeralHead

38mmx18mmOffset

HumeralHead

42mmx16mmOffset

HumeralHead

42mmx20mmOffset

HumeralHead

46mmx16mmOffset

HumeralHead

Notes

INTERNAL USE ONLY 3

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I/SRadiusofCurvatureMismatch(mm)

Glenoids Humeral Heads

Size 38 Size 42 Size 46 Size 50 Size 54

Size38 8* 6 4 2 0

Size42 10 8 6 4 2

Size46 12 10 8 6 4

Size50 14 12 10 8 6

Size54 16 14 12 10 8

A/PRadiusofCurvatureMismatch(mm)

Glenoids Humeral Heads

Size 38 Size 42 Size 46 Size 50 Size 54

Size38 12* 10 8 6 4

Size42 14 12 10 8 6

Size46 16 14 12 10 8

Size50 18 16 14 12 10

Size54 20 18 16 14 12

*Sizepairingingrayrepresentrecommendedmismatch

Humeral Head and Glenoid Radius

of Curvature Mismatch

The Turon system is designed with a radius of curvature

mismatch between the humeral heads and the glenoid

components. The mismatch is dierent in the A/P and I/S

planes to optimize stability while allowing translational

articulation. Highlighted size pairings represent

recommended mismatches (see matrices).

ProximalHumeralPreparationforLesserTuberosity

orSubscapularisRepair

• Itispreferredtostaggerdrillholestoavoid

fractureofthegreatertuberosity

HumeralStemPress-fitTechnique

• Ifdesired,usecancellousbonefromtheresected

humeralheadtoperformimpactionbone

graftingortobonegraftanysmalldefectsand

ensureasecurepress-t.

HumeralImplantAssembly

• ForinstanceswhenanAngledHumeralNeck

isusedincombinationwithanOsetHumeral

Head,besuretopositionordialinthedesired

positionoftheAngledHumeralNeckrelativeto

theOsetHumeralHeadpriortoinitiatingthe

Morsetaper.

INTERNAL USE ONLY

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Frequently Asked Questions (FAQ)

1 General

1. Will Turon replace Foundation? If so, what will

happen to the Foundation Fracture System?

Yes,TuronwillreplacetheFoundationShoulder

System.Thiswillnothappenovernightandtherewill

beamplecommunicationsontheFoundationphase-

outplan.TheFoundationFractureSystemwillnotbe

phasedoutandwillcontinuetobesupported.

2. What is the IMIN™ neck technology? What does

IMIN stand for? Does any other company have a

similar technology?

TheIMIN™necktechnologyisdesignedtohelp

surgeonsdialintorestorepatientanatomy,optimize

jointstability,andimproverangeofmotion.IMIN

isanacronymforIntrinsicModularIndexable

Neck.Turonisthersttotalshouldersystemto

incorporatethistechnology.Noothercompanyhas

thistechnologyasitispatentedandownedbyDJO

Surgical.TheIMINnecktechnologyoriginatesfrom

ourhipstemsandiscurrentlyusedinourR-120and

AlfaIIhipstems.

3. What does Turon stand for?

ThenameTurondoesnotstandforanything.When

thenameTuronwasconceived,ithadnoreference

and/orbearingtoanypopularculture,themeor

translations.Coincidentally,Turondoestranslateto

“Polecat”inSpanishandisalsoaPhilippinebanana

snack–whichareprettyfunny.

4. What is a “Ream-and-Run” technique? Do we

have instruments for that?

The“ReamandRun”surgicaltechniquewas

developedbyDr.FrederickA.Matsen,III,ofUW

WashingtonMedicine,OrthopedicsandSports

Medicine,andinvolvesusingsmooth-facedglenoid

reamerstoplaneoandremovedamagedcartilage,

bonydefects,and/orglenoidbiconcavitiesduring

shoulderhemiarthroplasty,inwhich,noglenoid

implantisused.

“…the“reamandrun”approachmayallowactive

patientstoremaininvolvedintness,recreational,

andvocationalpursuitsthatwouldriskpremature

failureiftraditionaltotalshoulderarthroplastywere

tobeperformed.”1

Currently,DJOSurgicaldoesnotoerdedicated

instrumentationforthisprocedure.

1http://www.orthop.washington.edu/reamandrun

5. Are there any Turon sample sets, demo

instrument sets and/or acrylic models?

Therearecurrently20+Turonsampledemokits,

ofwhich,7arecurrentlyconsignedand13arein

circulation.

Thereare4marketinginstrumentsets,3ofwhichare

completeand1isincomplete,fordemonstrations,lab

andmeetingsupport.

Renderedplasticimplantacrylicmodelsareavailable

fororderanddemonstrationpurposes.Please

contactRaePepperatRae.Pepper@djoglobal.comto

placeanorder.

6. Are there digital templates for Turon? How do I

find out if my hospital or surgery center has access

to digital templates for Turon?

Yes,digitaltemplatesareavailableforTuron.In

ordertolearnwhetheryourhospitalorsurgery

centerhasaccesstothedigitaltemplates,youmust

rstndoutandcommunicatetoDJOSurgicalthe

MedicalImagingandPACS(PictureArchivingand

Communication)systemusedatthatfacility.

Intheeventthatyourfacilitydoesnothaveaccessto

Turondigitaltemplates,itmaytakeupto3monthsto

processtherequest.Weencourageyoutoaskyour

facilityandbegintheprocessasearlyaspossible.

Alternatively,hardcopiesoftheTuronx-ray

template(804-88-117)areavailablefororderthrough

CustomerService.

7. Is the angle of retroversion of the humerus

(shoulder joint) always 30°? How is it referenced?

No,itisnot.Thenormalangleofretroversionofthe

humerusisbetween20°and40°,withtheaverageof

30°asthegenerallyacceptedstandard.

“Theangleofretroversionistheangleformedbya

linedrawnthroughthecenterofthelongitudinal

INTERNAL USE ONLY 5

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Frequently Asked Questions (FAQ)

axisoftheneckandheadofthehumerusmeetinga

linedrawnalongthetransverseaxisofthecondyles,

whenthebaseisviewedfromabove,looking

straightdownfromabovetheheadofthehumerus;

thenormalangleofretroversionofthehumerusis

between20and40degrees(seeFigurebelow).”2

2.www.medilexicon.com

8. What is the correct amount of height dierence

between the superior aspect of the humeral head

to the greater tuberosity?

“Thearticularheadalwaysliesabovethegreater

tuberosity,butthedierencecanrangefrom

3-20mm.”3

Yoursurgeonwilldeterminethecorrectamountof

heightdierencewithinthisrange.Thegenerally

accepteddierenceisabout8mm.

3http://emedicine.medscape.com/article/1261320-overview#a04

9 . Who are the surgeon designers of the Turon?

MarkA.Frankle,MD–FloridaOrthopedicInstitute,

Tampa,FL

MarkA.Mighell,MD–FloridaOrthopedicInstitute,

Tampa,FL

RichardJ.Hawkins,MD–SteadmanHawkinsClinic

oftheCarolinas,Greenville,SC

KeithC.Watson,MD–OrthopedicSpecialty

Associates,FortWorth,TX

SperoG.Karas,MD–EmorySportsMedicineCenter,

Atlanta,GA

TheodoreF.Schlegel,MD–SteadmanHawkinsClinic

Denver,Denver,CO

2 Instrument

10. Does Turon instrument set have the same

retractors, i.e. – plastic darrach (t-shaped),

brown deltoid, two-prong glenoid, as in the RSP

instrument set? What retractors are available?

No,therearenoretractorsintheTuroninstrument

trays.Therearecurrently3dedicatedShoulder

RetractorloanersetsavailablethroughDistribution

Services.

11. The OR sta has a hard time attaching the

Glenoid Drill Guide Handle (804-25-040) to the

Glenoid Sizing/Drill Guide, 38mm – 54mm (804-25-

142_146). What would you recommend? Is there an

alternative handle we can use?

TheGlenoidDrillGuideHandlehasaspring-loaded

threadedtip.Toensureproperassembly,thespring-

loadedtipmustbeushagainsttheGlenoidSizing/

DrillGuidepriortoengagingthethreads.Tofacilitate

attachment,itisrecommendedtothreadthedrill

guideintothehandleratherthanthehandletothe

drillguide.

Alternatively,therearetwoGlenoidPressurizer/

PusherHandles(804-25-037)availablethancan

beusedassubstitutes.Pleasenotethatonlythe

rstthreadortwoofthesehandlesaresucient

toengagethedrillguide.Lastly,theFoundation

ShoulderGlenoidTemplateHandle(804-01-013)can

alsobeusedasasubstitute.

Retractors and quantities in the Shoulder Retractor Sets are as follows:

Qty Part No. Description

1804-00-097 GlenoidProtector

1804-00-098 DeltoidRetractor

1804-00-099 HumeralRetractor

1804-00-200 Darrach,Small

1804-00-201 Darrach,Large

2804-00-202 SpikedHohmann

1804-00-203 AnteriorGlenoid

1804-00-204 SmallPectoral

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6

Frequently Asked Questions (FAQ)

12. Is the backside curvature or spherical radius

the same for all the Turon Glenoid Reamers, 38mm

– 54mm (804-25-142_146)? What about for Turon,

Foundation, and RSP?

Whilethediametersizesaredierentamongthe

Turonglenoidreamers,thebacksidecurvatureor

thesphericalradius,whichis38mm,isthesame

forallglenoidreamers.ThisisalsotrueforTuron,

Foundation,andRSP.

13. The Proximal Humeral Protector, Small/Large

(804-05-148_149)/Planer Guide, Straight/Angled

Neck (804-05-052_053)/Neck Trial, Angled/Straight

(804-15-005_006) is stuck on the Humeral Broach,

6mm – 16mm (804-05-106_116)/Humeral Stem,

6mm – 16mm (520-01-006_016) implant, what

should I do?

TheHumeralNeckExtractor(804-15-003)isavailable

toextractanyoftheabovementionedinstruments

andimplants.

14. What do the depth lines on the Humeral

Reamers, 6mm – 16mm (804-05-086_091) represent?

Startingfromtoptobottomorproximaltodistal,the

depthlinesonthehumeralreamersare“REVISION”

forrevisionorlongstem,“CEMENT”forcemented

application,and“PRESSFIT”forpress-tapplication.

15. Are the Turon humeral reamers the same as the

RSP reamers? What about the broach handles?

No,boththeRSPhumeralreamersandbroach

handlesaredierentfromTuron.

16. Is there separate instrumentation for the

revision/long humeral stems?

No,thereisnodedicatedrevision/longhumeralstem

instrumentation.Thesamehumeralreamersand

broachesareusedforrevision/longstemapplications.

PleaserefertotheRevision/LongStemsectionofthe

surgicaltechnique.

17. How do I order revision/long humeral stems

(520-01-106_116) should my surgeon request them?

Revision/longhumeralstemscanbeorderedthrough

DistributionServicesasloanerbanks.

18. Are there dedicated revision instruments?

Yes,therearededicatedrevisioninstruments.Below

isalistingoftherevisionandrelatedinstruments.

Pleaserefertothe“Revision”sectionoftheTuron

surgicaltechnique.

• HeadDistractor(804-05-046)

• HumeralNeckExtractor(804-15-003)and

RatchetingHandle(804-05-163)

• StemExtractor(804-05-047)

• HumeralBroachHandle(804-05-007)

19. The plastic cap on the Glenoid Drill Guide Pusher

(804-25-132) is damaged or missing, is there a

replacement?

Yes,thepartnumberfortheGlenoidDrillGuide

PusherReplacementCapis(804-25-232).Please

contactCustomerServiceforareplacement.

20. The screw to the Back Table Fixture (804-15-

102) is damaged or missing, is there a replacement

screw?

Yes,thepartnumberfortheBackTableFixture

ScrewReplacementis(804-15-202).Pleasecontact

CustomerServiceforareplacement.

3 Implant

21. What are the lengths of the primary and revision

humeral stems? Are they oered in the same

diameter sizes?

Thetablesbelowsummarizethehumeralstem

lengthsforbothprimaryandrevision/longstems.

Bothareoeredindiameters6,8,10,12,14and16mm

diametersizes.Lengthismeasuredfromtheproximal

apextothedistaltipofthehumeralstem.

INTERNAL USE ONLY 7

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Frequently Asked Questions (FAQ)

PRIMARY HUMERAL STEMS

Cat. No. Size (mm) Length (mm)

520-01-006 6115

520-01-008 8114

520-01-010 10 113

520-01-012 12 112

520-01-014 14 111

520-01-016 16 110

REVISION/LONG HUMERAL STEMS

Cat. No. Size (mm) Length (mm)

520-01-106 6200

520-01-108 8199

520-01-110 10 198

520-01-112 12 197

520-01-114 14 196

520-01-116 16 195

22. Why is a reverse (a.k.a. – female) Morse taper

important?

AreverseorfemaleMorsetaperprovidesforan

unobstructedaccessandpreparationoftheglenoid

facecomparedtoastandardormaleMorsetaper,

suchasintheFoundationstems.

23. What is the advantage to a collared humeral

stem design?

Acollaredstemhelpstopreventsubsidenceduringin

situ(inthebody)implantassembly.

24. Do the humeral heads sit flush on the humeral

osteotomy? Is there any gapping between the

humeral head and the osteotomy similar to

Foundation?

Thehumeralheadsaredesignedtoseatonthe

humeralneckswithsomeclearancebetweenthe

undersideoftheheadandtheosteotomy.Thisisto

preventtheriskofnon-engagementoftheMorse

taperduringinsitu(inthebody)implantassembly.

Thisclearanceisminimal,upto3.81mm(1.4mm

visiblegapbetweenthetopofthehumeralstem

collarandthehumeralhead)atitsgreatest,between

thehumeralheadandosteotomy,andcanbe

imperceptibleonradiographs.Thisclearanceisnotto

theextentofthegappingseenonFoundation,which

isabout5mm.

25. Are the Foundation and Turon humeral heads

compatible and interchangeable with each system’s

respective humeral stems?

Otherthandierencesinhumeralheadheight

oerings,theTuronandFoundationhumeral

headsareequivalentandarecompatibleand

interchangeable.

TheFoundationhumeralheadheightsare

17/22/27mmforalldiametersizes,i.e.–38,42,46,

50,54mm.Whereas,theTuronheightsare38mmx

14/16mm,42/46mmx14/16/20mm,and50/54mmx

18/22/26mm.

Note: There are no humeral head trials to allow for

interchangeable humeral head trialing between the two

shoulder systems.

26. What is the amount of oset on the Oset

Humeral Heads?

Theosetforallhumeralheadsizesis4mm.

27. Why is there not a 38mm x 14mm oset humeral

head size?

Itwasnotpossibletodesigna4mmosetintoasize

38mmx14mmhumeralhead.

28. In what situations would the Angled (7.5-degree)

Humeral Neck (520-00-001) be used?

Theangledhumeralneckwouldhelptreatpatients

withvariableneck-shaftanglesthatarenot135°to

allowforproperbiomechanicsandthereproduction

ofthehumeralcenterofrotation.

INTERNAL USE ONLY

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8

Frequently Asked Questions (FAQ)

29. What is the amount of press-fit on the humeral

stems?

TheproximalplasmasprayontheTuronhumeral

stemsprovidesa0.5mmoverallpress-t.

30. In what situations would the medial hole and

the anterior and posterior fin suture holes on the

humeral stem be used?

Theseholesareallsutureholesandareprimarilyused

fortuberosityrepairandxationduring3and4-part

proximalhumeralfracturerepairinhemiarthroplasty.

Theycanalsobeusedforadjunctivesofttissuerepair

andimplantxationforhemiarthroplastyandtotal

shoulderarthroplasty.

31. What is the

purpose of the recess

(see below Figure

with red arrow) at

the medial aspect

under the collar of

the humeral stem?

Therecessisdesigned

forthetipoftheStem

Extractor(804-05-

047)toseatinto

duringhumeralstem

removal.

32. What is the tiny metal wire that is embedded in

the glenoids central keel and superior peg for?

Itisatitaniumwirethatservesasaradiographic

markertoassessandviewglenoidplacementand

positioning.

33. Are the humeral stems similar between Turon

and Foundation?

No.TheTuronhumeralstemisshorterandhasa

smallerproximalbodycomparedtotheFoundation

humeralstem.ItalsohasareverseorfemaleMorse

taperdesignversusastandardormaleMorsetaper

design.Additionally,thelateralaspectoftheproximal

bodyisreducedandthereisnolateraln.Lastly,the

TuronhumeralstemshavethepatentedIMINneck

technologydesignedintothem.

34. What is the purpose of humeral head and

glenoid mismatch?

Thereisanaturalanatomicalmismatchinthe

radiusofcurvaturebetweenthehumeralheadand

glenoidfacethatcontributestopropershoulderjoint

biomechanics.Insimplerterms,thehumeralhead

curvatureis(generally)smallerthantheglenoidface

curvature.4Thismismatch,specicallyforshoulder

implants,rangesfrom0to10mm,withsomestudies

showinganoptimalmismatchrangebetween6and

10mm.5Restoringproperglenohumeralmismatch

inshoulderarthroplastycontributestoasuccessful

surgicaloutcome.

4”Thenormalglenohumeralrelationships.Ananatomicalstudyofone

hundredandfortyshoulders.”Iannottietal,JBoneJointSurgAm.1992

Apr;74(4):491-500.

5”Theinuenceofglenohumeralprostheticmismatchonglenoid

radiolucentlines:resultsofamulticenterstudy.”Walchetal,JBoneJoint

SurgAm.2002Dec;84-A(12):2186-91.

35. Can my surgeon upsize or downsize the humeral

head and glenoid size pairing?

Wecannotadvisesurgeonshowtoupsizeor

downsizehumeralheadandglenoidsizepairings

asitisanOFF-LABELuse.However,wecaninform

surgeonswhatthehumeralheadandglenoid

mismatchvaluesareamongdierentsizepairings

byreferringthemtothe“HumeralHeadandGlenoid

RadiusofCurvatureMismatchChart”.Onlythe

(0.25mmeachside)

INTERNAL USE ONLY 9

Dial In

surgeoncandecideoropttomismatchhumeralhead

andglenoidsizepairings.

36. The pegs are too long on the glenoid, can we cut

them down?

Yes.

37. What is the neck shaft-angle on the humeral

stem?

Thehumeralneck-shaftangleis135°.Dependingon

referencepoint,itcanalsobereferredtoas45°.

38. How is the humeral

neck-shaft angle

determined?

Usingan

anteroposterior

(A/P)radiograph,the

humeralneck-shaft

angleisdetermined

bytheintersection

ofalinedrawnon

thecentralaxisof

thehumeralshaft(A)

withalineCdrawn

perpendiculartothe

anatomicalneck(B)ofthehumerus.6

6http://www.springerimages.com/ImagesMedicineAndPublic

Health/1-10.1007_s10195-008-0019-1-1

39. What is the dierence in length between the

superior peg and the inferior pegs of the pegged

glenoid? Why the dierence?

Forthesize38mmglenoidonly,thedierence

betweenthelongersuperiorpegandshorterinferior

pegsis3.6mm.Allothersizes,i.e.–42to54mm,the

dierenceis1.7mm.

Thedierenceinlengthsisattributedtotheanatomy

oftheglenoid,wheretheglenoidvaultisgenerally

largersuperiorly.

40. What is the backside curvature for the Turon

and Foundation glenoids?

ThebacksidecurvatureforallTuronglenoids

is38mm.

Frequently Asked Questions (FAQ)

4 Conversion: Turon-RSP

41. Will my surgeon be able to

convert the Turon to an RSP?

Yes,theTuron-RSPconversionadaptorsareavailable.

TheTurontoRSPConversionModuleTrials,Oset

(804-02-074)andNeutral(804-02-073),willbe

backlledwiththeTuroninstrumentsetsandwillbe

housedinmiscellaneousboxintheTuronHumeral

HeadCase.TheTurontoRSPConversionModule

Implants,Oset(508-02-001)andNeutral(508-02-

000),areavailablethroughDistributorServices.

42. Can we promote the Turon humeral stem

combined with the Turon-RSP conversion adaptor

to our surgeons as a “press-fit” reverse shoulder?

No,thepromotionanduseoftheTuronhumeral

stemwiththeTuron-RSPconversionadaptorasa

“press-t”reverseshoulderisstrictlyOFF-LABEL.

43. Can we use Turon humeral heads

with the hemi adaptors for the RSP when

converting to a hemiarthroplasty?

Yes.DedicatedModularRSPtoTuronConversion

ModuleTrialshavebeenbacklledtoexisting

Turoninstrumentsetsandarehousedin

themiscellaneousboxintheTuronHumeral

HeadCase.Thetrialscomeintwosizes,6mm

(804-02-076)and12mm(804-02-077).

5 Surgical Technique/Procedure

44. The humeral shaft fractured during humeral

broaching/reaming, what should we do?

Regardlessofexperience,situationsliketheseare

oftentoughandveryunpredictable.However,

therearecertainsurgicalcasesthatprovide

informationtohelppreemptandprepareforthese

toughsituations,suchas,arevisionofapress-tor

cementedhumeralstem,humeralshaftdeformities

andmalunions,shortand/ornarrowhumeralcanals

–arejustafewexamples.

Topreparefororinthemidstofthesesituations,

besurethattheORstahasaccesstoanyofthe

135⁰

45⁰

INTERNAL USE ONLY

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10

Frequently Asked Questions (FAQ)

followinglistedtohelpwithfracturerepairand

completingthesurgicalprocedure.

• Revision/longhumeralstem

• C-armoruoroscope

• Cableset

• Bonecementremovaldevice(ifrevising/

removingacementedstem)

• SmallFragmentSet

• Allograft/graftingagent

Note: This is just an example list and should not be

viewed as standard list for all fracture situations.

45. When using an oset humeral head, how does a

surgeon mark or reference the determined humeral

head oset position on the humeral osteotomy?

Eachsurgeonwillhavetheirownmethodtomark

orreferencethepositionofthehumeralheadoset.

Acommonpracticeistouseanelectrocautery

orsurgicalpentomarktheosetpositionon

thehumeralosteotomysurfaceviaadetermined

landmark,suchasthebicipitalgroove.

46. After the surgeon planed the humeral

osteotomy with the planer disk and guide, there

is some residual bone. What should we do?

Removeanyresidualbonewithasmall

burrorotherpreferredmethodologyto

assuretherearenobonyimpediments.

47. What should we do when we are

in between sizes among humeral

stems? Humeral heads? Glenoids?

Intheeventthatyoursurgeonisinbetweensizes

amonghumeralstems,headsorglenoids,itis

prudenttogosmallerversuslargertoprevent

therisksofstressfracture,jointoverstu,implant

overhang,orimpingement.

48. My surgeon is experiencing diculty dislocating

the humeral head, what should I advise?

Inordertodislocatethehumeralhead,the

dissectionshouldbedirectedtothemedialhumeral

neck.Toaccomplishthisrequiresthatthearmis

externallyrotatedandthecapsuleisreleasedfrom

anteriortoposterioralongthemedialhumeralneck.

Dislocatetheheadanteriorlybycarefullyexternally

rotatingandextendingthearm.Gentleleverage

fromaDarrachorHohmannretractorfacilitates

humeralheaddislocationandhelpsretractthe

medialsofttissuesofthesubscapularis,pectoralis

major,andconjoinedtendon.Toreducethe

incidenceofintra-operativehumeralshaftfracture,

gentleexternalrotationandhumeralextension

shouldbeusedtodeliverthehumeralhead.A

DarrachorHohmannretractorattheposterior

surfaceofthehumeralheadcanbeusedasaskidto

levertheheadoutofthejoint.

6 Fractures

49. What are the critical factors in

addressing 3 and 4-part proximal humeral

fractures with a hemiarthroplasty?

Thecriticalfactorstoasuccessfuloutcomein

3and4-partproximalhumeralfracturesusing

hemiarthroplastyare:

• Properstemheight

• Properstemretroversion

• Propertuberosities(lesserandgreater

tuberosity)repair

• Jointstability

Preoperativeassessmentoftheproximalhumeral

comminutioniscriticaltoallowthesurgeonto

placethehumeralcomponentattheproperheight.

Comminutionofthemedialhumeralneckshouldbe

assessedandpiecesmeasuredtohelpidentifythe

positioninwhichthehumeralstemcomponentmust

beplaced.74-partfracturestypicallyfractureatthe

humeralneckpreservingthemedialcalcar,whichis

agoodreferenceforheightandversionrestoration

whenaligningwiththemedialaspectofthehumeral

stemcomponent.

Thestemsizeisusuallydeterminedonpreoperative

radiographsandevaluatedinatraoperatively

withhumeraltrialbroacheswhichbestt

thecanal.Thelargeststemwhichwillallow

adequateseatingandstabilityandcementingis

INTERNAL USE ONLY 11

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Frequently Asked Questions (FAQ)

chosen.8Analternativemethodistotemplate

theunaected/uninjuredhumeruswitharuler

toassistwithdeterminingproperlengthand

restorationofproximalhumeralanatomy.

Versionandheightcanbedeterminedthrough

trialreduction.Versionisdeterminedbyexingthe

elbowto90°andthetransverseepicondylaraxis

oftheelbowto0°.Thearmisexternallyrotated

toapointwherethehumeralheadwouldpoint

directlytotheglenoid.Thisisusuallybetween

30°and45°ofretroversion.9Abroachhandlewith

alignmentrodattachmentcanalsoassistwith

determiningproperhumeralstemcomponent

version.Aspongeorlappadcanbeplaced

aroundthebroachtrialorprosthesisanditcan

beimpactedintothecanal,allowingforenough

stabilitytodeterminetheappropriateheightof

thestemcomponentpriortocementing.10

Nonabsorbablesuturesareplacedatthebone

tendoninterfaceforretraction,reductionandrepair.

Alternatively,tuberositiescanbepinned.Reducethe

tuberositiestotheirnearanatomicpositionsbefore

cementinginthehumeralstemcomponent.Proper

humeralheadandstemcomponentplacement

shouldallowA/Ptranslationofapproximately50%,

andwhenthearmispulleddownthehumeralhead

shouldnotfallbelowthemidpointoftheglenoid.11

7-11“HemiarthroplastyforComplexFour-PartFractureoftheProximal

Humerus:TechnicalConsiderationsandSurgicalTechnique.”Dinesetal,

TheUniversityofPennsylvaniaOrthopaedicJournal15:29-36,2002.

50. Is there any dedicated fracture

instrumentation for Turon?

Therecurrentlyisnotanydedicatedfracture

instrumentationforTuron.However,thereis

dedicatedfractureinstrumentationthroughthe

FoundationFractureSystem.

51. Can I use the Foundation Fracture trials with

Turon for fracture cases?

No.TheFoundationFracturetrialsarenotcompatible

withtheTuronhumeralstems.Theproximal

bodyoftheFoundationislargerandthedistal

humeralstemislongercomparedtotheTuron.

52. Should I bring the RSP system as

a back-up to Turon for 3 and 4-part

proximal humeral fracture cases?

Yes,forinstanceswherecuteararthropathy

oranirreparablerotatorcuissuspected

andunderthedirectionofthesurgeon.

INTERNAL USE ONLY

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12

Chemical Composition of Turon Implants

ShoulderComponents CommonName Composition ASTMSpec

HumeralHeads CobaltChrome CoCrMo F799/F1537

HumeralNecks TitaniumAlloy Ti-6Al-V4 F136

HumeralStems TitaniumAlloy Ti-6Al-V4 F136

Glenoids Polyethylene UHMWPE F648

PorousCoatingonProximalStem

RadiographicMarkerinGlenoids

UnalloyedCommercially

PureTitanium CPTi F67

Chemical Composition of Turon Implants

Element Composition, %

(mass/mass)

Nitrogen,max.................................................................................0.05

Carbon,max...................................................................................0.08

Hydrogen,max.............................................................................. 0.012A

Iron,max...................................................................................... 0.25

Oxygen,max...................................................................................0.13

Aluminum................................................................................5.5—6.50

Vanadium..................................................................................3.5—4.5

TitaniumB..................................................................................balance

AMaterial0.032in.(0.813mm)andundermayhavehydrogencontentupto0.0150%.

BThepercentageoftitaniumisdeterminedbythedifferenceandneednotbedeterminedorcertified.

ASTM F136 — Titanium Alloy

Chemical Requirements

INTERNAL USE ONLY 13

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Chemical Composition of Turon Implants

Property Test Method Requirement

Resin Type Type 1 Type 2 Type 3

ViscosityNumber,mL/g, ASTMD4020(0.02%) 2000-3200 >3200 >3200

ElongationStress,(Minimum)† ASTMD4020 0.20 0.42 0.42

Ash,mg/kg,(Maximum) ISO3451-1 125 125 300

ExtraneousMatter, 4.2.1 3 3 25

No.Particles,(Maximum)

Titanium,mg/kg,(Maximum) 7.1.3.1 40 40 150

Aluminum,mg/kg,(Maximum) 7.1.3.1 20 20 100

Calcium,mg/kg,(Maximum) 7.1.3.1 5 5 50

Chlorine,mg/kg,(Maximum) 7.1.3.2 30 30 90

†Editoriallycorrected.

ASTM F648 — Polyethylene

Requirements for UHMWPE Powders

Composition % (mass/mass)

Element

Alloy 1

UNS R31537

(Low Carbon)

Alloy 2

UNS R31538

(High Carbon)

Alloy3

UNS R31539

(Dispersion Strengthened)

 min max min max min max

Carbon ...... 0.14 0.15 0.35 ...... 0.14

Aluminum ........................ 0.30 1.00

Lanthanum ........................ 0.03 0.20

Chromium 26.0 30.0 26.0 30.0 26.0 30.0

Molybdenum 5.0 7.0 5.0 7.0 5.0 7.0

Nickel ...... 1.0 ...... 1.0 ...... 1.0

Iron ...... 0.75 ...... 0.75 ...... 0.75

Silicon ...... 1.0 ...... 1.0 ...... 1.0

Manganese ...... 1.0 ...... 1.0 ...... 1.0

Nitrogen ...... 0.25 ...... 0.25 ...... 0.25

CobaltA Balance Balance Balance

AApproximatelyequaltothedifferenceof100%andthesumpercentageoftheotherspecifiedelements.Thepercentageofcobalt

differenceisnotrequiredtobereported.

ASTM F799/F1537 — Cobalt Chrome

Chemical Composition

INTERNAL USE ONLY

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14

Composition, % (mass/mass)

Element Grade 1

UNS R50250

Grade 2

UNS R50400

Grade 3

UNS R50550

Grade 4

UNS R50700

Nitrogen,max 0.03 0.03 0.05 0.05

Carbon,max 0.08 0.08 0.08 0.08

Hydrogen,maxB 0.015 0.015 0.015 0.015

Iron,max 0.20 0.30 0.30 0.50

Oxygen,max 0.18 0.25 0.35 0.40

Titanium balance balance balance balance

AForgingsaredesignatedGradeF-1,F-2,F-3,orF-4respectively.ForgingcompositionsareasspecifiedinTable1.

BMaximumhydrogencontentforbilletis0.0100wt%.

ASTM - Unalloyed Titanium

TABLE 1 Chemical Requirements

Chemical Composition of Turon Implants

PRIMARY HUMERAL STEMS REVISION/LONG HUMERAL STEMS

Cat. Number Size (mm)

“A”

Prosthesis

Length

(mm)

“B”

Stem Length

(mm)

Cat. Number Size (mm)

“A”

Prosthesis

Length

(mm)

“B”

Stem Length

(mm)

520-01-006 6115 77 520-01-106 6200 162

520-01-008 8114 71 520-01-108 8199 156

520-01-010 10 113 65 520-01-110 10 198 150

520-01-012 12 112 59 520-01-112 12 197 144

520-01-014 14 111 52 520-01-114 14 196 137

520-01-016 16 110 45 520-01-116 16 195 130

Key Dimensions

INTERNAL USE ONLY 15

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Key Dimensions

NEUTRAL HUMERAL HEADS

Cat. Number Siz

(mm)

“A”

Height

(mm)

“B”

Spherical

Diameter

(mm)

“C”

Ø Inner Diameter

(mm)

“D”

Spherical Offset

(mm)

“E”

Skirt

(mm)

520-38-014 38x14 14.0 19.0 31.4 7.6 2.6

520-38-018 38x18 18.0 19.0 33.6 3.7 2.6

520-42-016 42x16 16.0 21.0 35.7 7.6 2.6

520-42-020 42x20 20.0 21.0 37.6 3.7 2.6

520-46-016 46x16 16.0 23.0 38.4 9.7 2.6

520-46-020 46x20 20.0 23.0 41.0 5.7 2.6

520-46-024 46x24 24.0 23.0 42.0 1.7 2.6

520-50-018 50x18 18.0 25.0 42.7 9.7 2.6

520-50-022 50x22 22.0 25.0 45.1 5.6 2.6

520-50-026 50x26 26.0 25.0 45.9 1.7 2.6

520-54-018 54x18 18.0 27.0 45.4 11.7 2.6

520-54-022 54x22 22.0 27.0 48.3 7.6 2.6

520-54-026 54x26 26.0 27.0 49.7 3.7 2.6

INTERNAL USE ONLY

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16

OFFSET HUMERAL HEADS

Cat. Number Size

(mm)

“A”

Height

(mm)

“B”

Spherical

Diameter

(mm)

“C”

Ø Inner

Diameter

(mm)

“D”

Spherical

Offset

(mm)

“E”

Skirt

(mm)

“F”

Offset

(mm)

520-38-114 38x14 14.0 19.0 31.4 7.6 2.6 4.0

520-42-116 38x18 18.0 19.0 33.6 3.7 2.6 4.0

520-42-120 42x16 16.0 21.0 35.7 7.6 2.6 4.0

520-46-116 42x20 20.0 21.0 37.6 3.7 2.6 4.0

520-46-120 46x16 16.0 23.0 38.4 9.7 2.6 4.0

520-46-124 46x20 20.0 23.0 41.0 5.7 2.6 4.0

520-50-118 46x24 24.0 23.0 42.0 1.7 2.6 4.0

520-50-122 50x18 18.0 25.0 42.7 9.7 2.6 4.0

520-50-126 50x22 22.0 25.0 45.1 5.6 2.6 4.0

520-54-118 50x26 26.0 25.0 45.9 1.7 2.6 4.0

520-54-122 54x18 18.0 27.0 45.4 11.7 2.6 4.0

520-54-126 54x22 22.0 27.0 48.3 7.6 2.6 4.0

Key Dimensions

INTERNAL USE ONLY 17

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KEELED GLENOIDS

Cat. Number Size

(mm)

“A”

Length

(mm)

“B”

Width

(mm)

“C”

Thickness

(mm)

“D”

Keel Width

(mm)

“E”

Keel Length

(mm)

520-01-138 38 29.7 23.9 4.2 3.8 12.8

520-01-142 42 32.3 25.4 4.2 3.8 12.8

520-01-146 46 34.8 26.9 4.2 3.8 12.8

520-01-150 50 37.3 28.4 4.2 3.8 12.8

520-01-154 54 39.9 30.0 4.2 3.8 12.8

PEGGED GLENOIDS

Cat. Number Size

(mm)

“A”Length

(mm)

“B”Width

(mm)

“C”

Thickness

(mm)

“D”

Center

Peg Length

(mm)

“E”

Δ Between

Center Peg and

Superior Peg

(mm)

“F”

Δ Between

Center Peg and

Inferior Pegs

(mm)

520-01-238 38 29.7 23.9 4.2 15.0 3.2 7.4

520-01-242 42 32.3 25.4 4.2 15.0 3.2 5.3

520-01-246 46 34.8 26.9 4.2 15.0 3.2 5.3

520-01-250 50 37.3 28.4 4.2 15.0 3.2 5.3

520-01-254 54 39.9 30.0 4.2 15.0 3.2 5.3

Key Dimensions

©2011 Encore Medical, L.P.

CAUTION: Federal Law (USA)

restricts this device to sale by

or on the order of a physician.

See package insert

for a complete listing of

indications, contraindications,

warnings, and precautions.

0031106-002RevA01/12

TM

DJO Surgical I A DJO Global Company

T 800.456.8696 D 512.832.9500 F 512.834.6300

9800 Metric Blvd. I Austin, TX 78758 I U.S.A.

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