Ideas and innovations

An aid to distal locking of the Russell±Taylorhumeral nail

Paul Harrington1 and Frank Howell2

1Leeds General Infirmary, Leeds, U.K. and 2Hull Royal Infirmary, Hull, U.K.

Injury, Vol. 29, No. 9, 732±733, 1998

Since the introduction of intramedullary interlockingnails there have been several technical aids put for-ward to assist and simplify the insertion of distallocking screws [1±5]. These techniques, which havebeen described for placing distal locking screws inthe femur are also applicable to intramedullary nail-ing of the humerus.

However the diameter of the humerus is muchless than that of the distal femur and because of itscurvature the tip of a drill or trocar has a greatertendency to slide on the surface of the bone. Also, inmore elderly patients with osteoporotic bone and inpatients with pathological fractures the humeral nailtends to move within the relatively wide medullarycanal effectively rendering the distal locking slot a``moving target''. We propose a simple idea to facili-tate the insertion of the antero-posterior distal lock-ing screw for the Russell±Taylor humeral nail.

Technique

Having inserted the intramedullary nail in an ante-grade manner, distal locking is performed using theRichards' 4 mm Cannulated Screw. This screw hasthe same diameter as the fully-threaded lockingscrew supplied with the nail. The guide wire for thecannulated screw has a narrow diameter of 1.3 mmand can easily be placed through the longitudinaldistal locking slot via a short stab incision using amodified freehand technique employing fluoroscopyin an AP direction (Figure 1). Confirmation of thecorrect positioning of the guide wire is obtained byrotating the patient's arm to obtain a lateral fluoro-

scopic view. The screw length is read directly from

the guide wire gauge and following passage of the

cannulated reamer the introduction of the cannu-

lated locking screw over the guide wire is a simple

matter which obviates the need for further screening

(Figure 2). This method also avoids the frustration of

failing to immediately relocate the drill hole after

drill removal, and shortens the time required for this

final part of the nailing procedure.

Injury Vol. 29, No. 9, pp. 732±733, 1998# 1998 Elsevier Science Ltd. All rights reserved

Printed in Great Britain0020-1383/98 $19.00 + 0.00

PII: S0020-1383(98)00136-3

Figure 1. Fluoroscopic confirmation of correct guide wireplacement in antero-posterior distal locking slot

Conclusion

This technical tip for aiding the distal locking ofRussell±Taylor humeral nails has proved gratify-ingly easy and has been used routinely by us allow-

ing a decreased operative time and a lower radiationexposure to the operators hands.

References

1 MacMillan M. and Gross R. H. A simplified techniqueof distal femoral screw insertion for the Grosse±Kempfinterlocking nail. Clinical Orthopaedics and RelatedResearch 1988; 226: 252±259.

2 Knudsen C. J. M., Grobler G. P. and Close R. E.W. Inserting the distal screws in a locked femoral nail.Journal of Bone and Joint Surgery (Br) 1991; 73B: 660±661.

3 Noordeen H. H., Sala M. J. and Belham G. J. Insertionof distal screws in interlocking intramedullary nails.Injury 1993; 24: 357±358.

4 Giddins G. E. B. An aid to interlocking screw insertion.Injury 1994; 25: 481±482.

5 Ohe T., Nakamura K., Matsushita T., Nishiki M.,Watanabe N. and Matsumoto K. Stereo fluoroscopy-assisted distal interlocking of intramedullary nails.Journal of Orthopaedic Trauma 1997; 11: 300±303.

Paper accepted 26 May 1998.

Requests for reprints should be addressed to: Mr P.Harrington, 100 Forest Avenue, Harrogate, NorthYorkshire, HG2 7JP, U.K.

Figure 2. Confirmation of satisfactory placement of distallocking screw

Harrington and Howell: An aid to distal locking of the Russell±Taylor humeral nail 733