Humerus Nailing in Lateral Position (Operative Technique)

Abstract

With the advent of good designs of nails, straight and angled in the arena of treatment for fractures from surgical neck of humerus to approximately 5 cm above the olecranon fossa, nailing is gaining popularity in recent literature. Many different nails are available in market with different proximal and distal locking configurations. Beach chair and supine are the main principle positions for antegrade humerus nailing. Beach chair or supine is the preferred position by many, but there is always difficulty in distal locking by free hand technique as it is difficult to locate the distal locking hole due to rounded smooth anatomy of anterior distal humerus and fear of neurovascular complications in both anteroposterior and latero-medial locking. The aim of this article is to demonstrate the utility of lateral position in ease of nailing all types of humerus fractures. The technique and illustrations below describe the positioning of patient, image intensifier and free hand postero-anterior distal locking without injury to neurovascular structures.

“Jahwari’s Position” – A Novel Operating Room Setup for Antegrade Humeral Nailing: Surgical Technique and Initial Experience

“…Ikpeme et al described the shoulder pain in the supine position and the associated distal neurovascular injuries, such as injury to the radial and axillary nerves [ 2 ]. This was also supported by the argument of Gadegone et al about iatrogenic injury during distal interlocking [ 3 ]. Blyth et al also studied the neurovascular risks in anteroposterior (AP) distal locking.…”