Intramedullary Nail for
Humeral Fractures

The efficacy of treating lower extemity fractures with intramedullary nailing has been documented in many studies. Intramedullary nailing offers the benefits of:

• Anatomic alignment
• Rigid fixation with limited soft tissue dissection
• Early rehabilitation of the injured limb

However, intramedullary nailing indications for humeral fracures should be viewed with caution. The anatomy and function of the humerus are quite different from the long bones of the lower extremity:

• The humerus is not a "weight-bearing" bone, therefore rigid internal fixation is not needed to maintain limb function during fracture healing.
• Whereas the intamedullary canal widens in the metaphyseal area of the tibia and femur, the humeral canal narrows, significantly increasing the risk of distal fragment comminution.
• The anatomy of the upper arm also predisposes the patient to an increased risk of soft tissue injury, particularly the rotator cuff.
• The potential for neurovascular injury is greater in humeral nailing than in the nailing of lower extremity fractures.

Before embarking on humeral nailing, one should understand the obstacles that can be encountered. Adwquate planning will minimize these dificulties. Rotator cuff injury, proximal humerus articular cartilage destruction, radial nerve injury, and extension of comminution are all possible complications of this procedure.

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