Nail entrance point enlarge

Correct nail entrance point

A proper and precise entrance point of the humeral nail is crucial. An incorrect entry site results in malreduction of the metaphyseal fracture. 


Reduce preliminarily enlarge

Preliminary reduction of the fracture helps with identification of the correct nail entry site. K-wire “joy-sticks” (as illustrated) or sutures through the rotator cuff insertions aid with reduction.


Reduce the metaphyseal fracture component enlarge

Reduction of the metaphyseal fracture component

If the entry point has been chosen correctly, insertion of the nail will help reduce the fracture.


Protect the axillary nerve enlarge

Protection of the axillary nerve

The axillary nerve is at risk of being injured by placement of distal locking screws of some humeral nails. The screw tract should be made to the bone with blunt dissection, checked with finger palpation if necessary.


Danger zone (axillary nerve) enlarge

Note the danger zone for screw placement, between 5 and 7 cm distal to the lateral edge of the acromion.


Anterolateral approach to the proximal humerus enlarge

Approach

An anterolateral incision is recommended for nailing of proximal humeral fractures. The need for additional access depends upon fracture type. Small separate stab incisions can be used for A2 fractures and extension (up to 6 cm) of the anterolateral incision may be needed for B- or C-type fractures.