Intramedullary fixation of complicated fractures of the humeral shaft.

Since 1973, a specially designed intramedullary nail has been used for fixation of humeral shaft fractures complicated by malalignment, multiple trauma, metastatic disease, radial nerve palsy, or nonunion. A series of 22 consecutive patients with good to excellent results in 20 patients (91%) is reported. The humeral anatomy is reviewed to illustrate the method and the rationale for intramedullary fixation. This method is advocated over routine use of compression plate and screws because incision and surgical time are both minimal, and the fracture site is not exposed in primary cases unless there is radial nerve involvement. Closed reduction remains the preferred treatment for most fractures of the humeral shaft.