The Anterior Acromial Approach for Antegrade Intramedullary Nailing of the Humeral Diaphysis

At three institutions, 71 humeral intramedullary nails were inserted into the shoulder; 67 were reviewed at 6 months and at completion of treatment. Fifty-one utilized the anterior acromial approach and 16 were inserted lateral to the acromion. Shoulder motion was rated as: excellent (asymptomatic and within 15 degrees of normal); good (normal daily function within normal motion); and poor. Nails were also inserted into the humeral diaphysis of eight cadaver shoulders. Fifty-one nails were inserted via the anterior acromial incision; 48 were graded as excellent, one as good, and two with traumatic axillary neuropathy and reflex sympathetic dystrophy as poor: Sixteen nails were inserted lateral to the acromion; 8 were rated, 7 good, and 1 poor. Motion returned in an average of 17 weeks (range:0-29). The greatest clinical concern is not ultimate shoulder function, but the rate of return. The authors conclude that either the anterior acromial approach or an extraarticular entry portal must be utilized for antegrade humeral diaphyseal nailing.