Distal interlocking during intramedullary nailing of the humerus

Distal interlocking of intramedullary humeral nails with current systems is performed from either the anterior or lateral approach. To evaluate the potential complications and difficulties of the lateral approach, the author's early experience with this technique in 14 patients was reviewed. In 13 patients, distal interlocking was performing without difficulty using a nailmounted targeting device. In 1 patient early in the series, an iatrogenic injury to the posterior antebrachial cutaneous nerve occurred and a screw missed its distal interlocking hole. No radial nerve injuries occurred. There were no malunions or nonunions. Distal interlocking using a lateral approach requires a careful open surgical technique to avoid nerve injury. In addition, the lateral cortex must be visualized to facilitate accurate drilling and screw insertion.