THE ANTERIOR ACROMIAL APPROACH FOR ANTEGRADE INTRAMEDULLARY NAILING OF THE HUMERAL DIAPHYSIS

At three institutions, 71 humeral intramedullary nails were inserted i nto the shoulder; 67 were reviewed at 6 months and at completion of tr eatment. Fifty-one utilized the anterior acromial approach and 16 were inserted lateral to the acromion. Shoulder motion was rated as: excel lent (asymptomatic and within 15-degrees of normal); good (normal dail y function within normal motion); and poor. Nails were also inserted i nto the humeral diaphysis of eight cadaver shoulders. Fifty-one nails were inserted via the anterior acromial incision; 48 were graded as ex cellent, one as good, and two with traumatic axillary neuropathy and r eflex sympathetic dystrophy as poor. Sixteen nails were inserted later al to the acromion; 8 were rated, 7 good, and 1 poor. Motion returned in an average of 17 weeks (range:0-29). The greatest clinical concern is not ultimate shoulder function, but the rate of return. The authors conclude that either the anterior acromial approach or an extraarticu lar entry portal must be utilized for antegrade humeral diaphyseal nai ling.