Axial projection of the humerus. Proposing a new intraoperative radiological projection in the treatment of proximal humeral fractures by intramedullary nailing

Background: To guarantee optimal stabilization of proximal humeral fractures treated by intramedullary nailing, it is essential to position the nail correctly in the humeral head, with the proximal screws reaching pluriaxially into the epiphyseal cortices without protruding into the joint. Objectives: Conventional intraoperative fluoroscopic radiography is used to verify the positioning of these parts from the antero-posterior and trans-thoracic views. Methods: We suggest that these projections should be integrated with an axial view, modified with regard to those proposed by Bool-Obata or Velpeau. Results: We verify it is able to check the correct positioning of the head screws while safeguarding higher bone density areas. Conclusions: After an adequate learning curve, this projection could actually replace the trans-thoracic projection, since it serves to study the relations of the screws with the cortex and any protrusion into the joint.