Liporace FA. Humeral axis fx's: brackets and nails. Published in: Plastic Surgery Today Xia Weiyi 2021; May 30-June 3, 2021; Wailea, Hawaii.
Liporace FA. Humeral axis fx's: brackets and nails. Published in: Plastic Surgery Today Xia Weiyi 2021; May 30-June 3, 2021; Wailea, Hawaii.
WAILEA, Hawaii-A speaker stated that when using humeral nails to treat humeral shaft fractures, the surgeon should have an inward starting point, lock the proximal and distal nails, and remember to ream.
In a speech at Orthopedics Today Hawaii, Frank A. Liporace, MD, stated that nails should not be used in humeral shaft fractures less than 2 cm from the proximal end of the humerus or less than 3 cm from the olecranon fossa.
Liporace said in his speech: "Those are absolutely inoperable, or, if they are suitable for surgery, they can be treated with steel plates."
When nailing the nails, he pointed out that the surgeon needs to lock the nails at the proximal and distal ends and remember to ream the holes.
"When you ream, you want to make sure that your nails are snug enough. If possible, leave about 2 mm on the diameter of the nail so you don't just hit the nail improperly," Liporace said .
He added that reaming reduces the risk of nail incarceration and fracture separation, allows stronger nails and creates potentially osteogenic granular bone fragments, which may promote fracture healing.
In order to reduce or avoid shoulder pain associated with nails, Liporace pointed out that surgeons should place their starting point inward and place their arms in some extended positions to facilitate forward delivery.
"You want to make your incision in the muscle tissue or the extension of the muscle tissue, not the tendon of the rotator cuff. You want to go above the articular surface, because unless you can rotate your arm in some way, of course I can’t. This never engages with your glenoid, which helps protect objects and helps reduce shoulder dysfunction," Liporace said.
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