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Nail insertion

Locking screw

Drill and determine length of locking screw

For distal locking, insert the two-piece trocar combination (aiming arm). Through an appropriately placed trocar, drill through both humeral cortices until the bit just breaks through the medial cortex, and read the depth from the drill bit. Alternatively, a depth gauge can be used.
Insert a locking screw through the trocar. A second screw is recommended, especially in osteoporotic bone.

Pearl: make one incision large enough to allow palpation of the axillary nerve.