Intramedullary nailing for humeral shaft fractures: the misunderstood poor relative

Closed intramedullary nailing has been an evolution in the treatment of diaphyseal fractures of femur and tibia. Surgeons have been trying to apply the principles and operative technique of the method to the treatment of humeral shaft fractures as well. However, there are fundamental anatomical and biomechanical differences which seem to have been underestimated. In addition, surgical treatment for humeral shaft fractures is often delayed, thus lowering the prospects for uneventful healing. As intramedullary nailing is not considered, by the majority of the surgeons, to be the treatment of choice for non-pathological, closed humeral shaft fractures, the search for the reasons may lead to useful thoughts about future developments in the area. (C) 2001 Harcourt Publisher's Ltd.