Fracture shaft of humerus with anterior dislocation of shoulder treated with closed locked nailing

Abstract

Correspondence: Dr. Hitesh Lal, A-1/207, Janakpuri, New Delhi – 110058. E-mail: drhiteshlall@gmail.com decided to take the patient to the operating room. The patient was taken up for surgery under general anesthesia in supine position with a sandbag below the ipsilateral shoulder. Close reduction of the dislocation was done under anesthesia with an assistant pushing manually on the head under the coracoid and another one applying traction along the axis of arm. The dislocation was surprisingly seen to reduce under radiographic control. It was decided to choose a closed interlocking nail over a plate for fixing the humerus as it is minimally invasive. But while making the entry point for the nail the head slipped again into a dislocated position even when the assistant resisted it manually with a fist pressure. A percutaneous 4 mm Steinmann pin was passed after reducing the head in an anteroposterior direction. Then 1 assistant held the head in reduced position with the help of the aforesaid pin loaded on a T handle. The operating surgeon was thus able to make an entry point with a thick Kirchner wire and the position was checked on anteroposterior and lateral views. A cannulated awl was passed over it to enlarge it and the shaft was then reamed with flexible reamer to appropriate size. A standard technique was then used to put an interlocking nail; proximal interlocking was done with the help of a targeting device and distal locking by a free hand technique. The nail of adequate length was appropriately buried in the head so as not to cause any impingement during range of motion. The rotator cuff incision at the entry site was sutured. The shoulder was then immobilized in an arm chest strapping after rechecking the position of head of humerus under C arm. Postoperative period was uneventful (Figure 2). Sutures were removed at 10 days and patient was mobilized at 15 days postoperatively. Initially pendulum exercises were started followed by shoulder range of motion and overhead abduction exercises within 10 days.