Lateral decubitus positioning with arthroscopic shoulder distractor for humeral intramedullary nail.

Objective: The objectives of this study are to (1) present a technique trick for intramedullary nailing of the humerus with the patient in lateral decubitus position and arm in an arthroscopic shoulder distractor to aid in utilizing the Neviaser portal to obtain access to a medialized start point and (2) present outcomes with this technique at a single institution. Design: Retrospective chart review. Setting: Academic Level 1 trauma center in South Carolina. Patients/Participants: Patients who underwent humeral nail fixation with this technique from March 2021 to March 2024 at a single academic level one trauma center were included. Intervention: Humeral intramedullary nail fixation. Main Outcome Measurements: Surgical duration, radiographic union, malunion rate, and rate of radial nerve palsy. Results: A total of 35 patients were included in the study. The median surgical duration was 60 minutes, with an estimated blood loss of 75 mL. Final intraoperative fluoroscopy images demonstrated no patients had greater than 10 degrees of varus/valgus or anterior/posterior angulation. All patients achieved radiographic union and none demonstrated malreduction at final follow-up. Two cases of postoperative radial nerve palsies occurred, yet neither was directly attributed to the nailing procedure. Conclusions: Intramedullary nailing of the humerus in lateral decubitus, combined with an arthroscopic distractor for a Neviaser portal start, is a reliable option for treating proximal and diaphyseal fractures. This technique achieved consistent union without radiographic malreduction. By minimizing the risk of rotator cuff violation, it can serve as a valuable addition to the orthopaedic traumatologist's operative armamentarium.