The Risk of Neurovascular Injury with Proximal Locking Screws of Antegrade Humeral Intramedullary Nails

Abstract

An anatomic study was performed in 75 fresh-frozen cadaver forequarter parts of upper extremities, without previous pathology, to assess the risk of injury of the axillary nerve, artery and veins from proximal locking screws in antegrade nailing of the humerus. The courses of the axillary nerve and vessels were defined in the medial, posterior and lateral aspects of the shoulder. The longitudinal distances from the medial aspect of the anatomic neck of the humerus and the axillary nerve and vessels were measured at the quadrangular space, and in the posterior and lateral aspects of the humerus. After insertion of a custom straight intramedullary nail with two 50° oblique lateral to medial proximal screws with 5 mm overpenetration in the medial cortex, the distance was measured between the medial aspect of the anatomic neck and the distal border of the tip of the more distal screw where there was no further screw-impingement in neutral, internal and external rotations, with the arm in adduction and in 90° and 170° abduction. The measured distances from the medial aspect of the anatomic neck of the humerus and the axillary nerve and vessels ranged between 9 and 28 millimetres, averaging 20 millimetres, with the humerus length ranging between from 275 and 323 millimetres. Protrusion of locking screws up to 5 millimetres beyond the medial cortex of the proximal humerus had no potential for damage to the axillary nerve and vessels provided that the overpenetration was located more than 30 millimetres distally to the medial anatomic neck of the humerus.

Key words

locked humeral nailing - proximal locking - injury to axillary nerve and vessels

References

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