Arthroscopy-Assisted Intra-Medullary Nailing for Treatment of Fractures of the Humeral Shaft

Abstract

Humerus fractures account for 3–5% of all fractures. Approximately two-thirds of these fractures occur at the shaft. Although conservative modality is mostly used to treat humeral shaft fractures, internal fixation methods such as plates and nails can also be used surgically. During antegrade nailing, entry site-related problems, especially rotator cuff injury, can be seen with the conventional method. It is possible to minimize these complications by arthroscopic imaging of the shoulder joint during nail application. The main benefits of arthroscopy-assisted technique include the ability to evaluate the accuracy of the nail entry site, checking for the level of the intra-articular nail to avoid im**ement, and less radiation exposure. After imaging is performed from the standard posterior portal and the entry site is determined, a guidewire is placed in the humeral medulla from the anterolateral edge of the acromion, as in conventional nailing. After fracture reduction and fixation are achieved, the joint is examined for any im**ement of the nail and penetration of proximal locking screws to the joint. Finally, the supraspinatus tendon, which is split for arthrotomy, is repaired.