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Technique for Free-Hand Posterior to Anterior Distal Locking in Interlock Humerus Nail

Distal locking of the humeral interlock nail can be done either in the anteroposterior or lateral-medial plane. Anteroposterior locking can jeopardize musculoskeletal nerve, lateral cutaneous nerve, median nerve, and brachial artery.1–3 For safe anteroposterior locking, many authors have recommended dissection lateral to the triceps tendon.3 Dissection lateral to medial locking can cause injury to the radial, ulnar and median nerves.1,3–5 Despite anatomic studies showing risk of neurovascular injury, iatrogenic nerve palsy is not commonly seen, and complete resolution has been observed in all cases.3,6,7 Posteroanterior locking has been regarded safer than the other 2 approaches.3 However, posteroanterior locking is difficult and tedious to accomplish in the supine decubitus or lateral position. Posteroanterior locking has traditionally been described in prone position. We describe a technique to perform free-hand posteroanterior distal locking in supine position.