Antegrade Intramedullary Nailing: Humerus Shaft Fractures
The patient was identified and the site of surgery confirmed. Under general anesthesia, with the patient in the modified beach chair position on a radiolucent table, the affected upper extremity chest and neck were shaved, prepped, and draped in the usual sterile fashion. All bony prominences were padded. Prophylactic intravenous antibiotics were given. Fluoroscopy was brought in to confirm visualization of the entire humerus in the AP and lateral planes and a closed reduction was performed. The surface anatomy was palpated and outlined. The humeral head diameter was palpated from anterior to posterior to locate the midline. A 3-cm longitudinal incision was made from the edge of the acromion and carried distally. The deltoid muscle was split in line with its fibers. The subacromial bursa was cleared bluntly with finger dissection. An incision was made in line with the fibers of the supraspinatus tendon, and the tendon edges were retracted.