Purpose: To evaluate the assumption that reaming is the main reason for problems of shoulder function (pain – restricted range of motion) after antegrade intramedullary nailing of humerus (unless impingement of fixation material on the rotator cuff or acromion occurs).

Materials – Methods: From January 1999 until March 2003 55 patients underwent unreamed antegrade intra-medullary nailing for treatment of recent fractures of the humeral shaft. Two different intramedullary nailing systems were used, that do not protrude from the humeral shaft and that do not require reaming for insertion. Patients with concomitant problems or complications that could affect the final functional result were excluded from the study (e.g. multiple injuries, brachial plexus lesions, etc.). The remaining 32 patients were examined for postoperative pain and functional problems in the shoulder joint.

Results: No patient complained of persistent shoulder pain. Range of motion was found comparable to that of the other shoulder.

Conclusions: Reaming seems to exert a harmful influence on the rotator cuff, due to direct injury caused by the reamers as they are inserted and withdrawn from the humeral head. Furthermore it is possible that bone reaming products, accumulating under the rotator cuff, contribute to the persistence of pain and loss of motion.

Purpose: To describe a technique that allows “closed” reduction and “percutaneous” fixation of intertrochanteric fractures that were unable to be reduced preoperatively, with the use of the Trochanteric Gamma Nail.

Materials-methods: From October 2001 until March 2003 we treated 11 patients with intertrochanteric fractures that were unable to be reduced with preoperative manipulation. To achieve “closed”, intaoperative reduction of fractures, the Trochanteric Gamma Nail was used as a lever. The operation was performed through a 2–3 cm long skin incision (“percutaneous technique”).

Results: There were no particular difficulties with this method. Stable fixation was achieved in all cases and mobilization, full-weight bearing, was allowed from the first day postoperatively. No intraoperative or postoperative complications occurred. Intraoperative blood loss averaged 150 cc.

Conclusion: Use of the TGN in the treatment of pre-operatively unreducible fractures can help to avoid an “open” reduction. Furthermore, placement of the nail through a minimal cutaneous incision can offer all the advantages of closed intramedullary nailing, such as reduced complications, small blood loss, and unrestricted, early mobilization of the patient.