Posterior to anterior distal locking of humeral intramedullary nails

TECHNIQUE Humeral nailing is performed with the patient in the lateral decubitus position with the image intensifier at 90o to the patient (Fig 1). During freehand distal locking, the patient’s arm rests on his or her body and the forearm is rested on the anterior pelvic support on sterile padding. By changing the amount of padding, arm rotation can be adjusted to give a perfect view of the distal locking hole without requiring an assistant. In this position, we then perform distal locking in a posterioranterior direction.