Start medially, lock and ream humeral nails in treatment of humeral shaft fractures
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WAILEA, Hawaii — When using humeral nails to treat humeral shaft fractures, surgeons should have a medialized starting point, lock the nail proximally and distally and remember to ream, according to a presenter.
In his presentation at Orthopedics Today Hawaii, Frank A. Liporace, MD, said nails should not be used in humeral shaft fractures that are less than 2 cm from the proximal humerus or less than 3 cm away from the olecranon fossa.
“Those are absolute either nonoperative or, if they are indicated for surgery, to plate,” Liporace said in his presentation.
When nailing, he noted surgeons need to lock the nail both proximally and distally and remember to ream.
“When you ream, you are making sure you are going to have an adequate fit of your nail. Get about 2 mm over the diameter of the nail, if possible, so you are not just pounding this nail in inappropriately,” Liporace said.
He added reaming decreases the risk for nail incarceration and fracture diastasis, allows for use of a stronger nail and produces potentially osteogenic morselized bone chips, which may enhance fracture healing.
To reduce or avoid shoulder pain associated with nailing, Liporace noted surgeons should medialize their starting point and place the arm in some extension for easy delivery anteriorly.
“You want to make your slit in the musculature or spreading of the musculature, not so much the tendon of the rotator cuff, and you want to enter the superior aspect of the articular surface because, unless you can rotate your arm in a way that I certainly cannot, that never engages with your glenoid and this helps preserve things and helps decrease shoulder disfunction,” Liporace said.
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Liporace FA. Humeral shaft fx’s: Brace vs nail. Presented at: Orthopedics Today Hawaii 2021; May 30-June 3, 2021; Wailea, Hawaii.
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