Humeral nails: When to choose what and how to use

Intramedullary nailing of the humerus is controversial. This may be partly because of the complicated anatomy and the unique biomechanical characteristics of the arm, and also because the principles and nail designs used for the treatment of femoral and tibial fractures have been directly transposed to this location. Over the last few years there have been several reports on the indications for humeral nailing, timing of the procedure, surgical technique, and nail design. As a result, surgeons witnessed the appearance of a wide variety of humeral nails with different biomechanical properties and implantation techniques, reflecting the disputes concerning intramedullary nailing in the humerus. In this article it is proposed that humeral nails should be categorised into two distinct groups (fixed and bio), according to their main characteristics and their use must follow guidelines that will be outlined, paying respect to the fracture pattern and location. Other issues such as the timing of surgery and the role of reaming are also addressed in an effort to further improve the results of intramedullary nailing in the humerus.