Over 11 months to January 2001, we stabilised 15 pathological humeral fractures (14 patients) with a new nail that is secured in the medullary canal by hydraulic inflation. Filled with Ringer’s solution through a unidirectional valve, the nail expands by up to 50% of its original diameter. The expanded nail’s cross-section is characterised by four external longitudinal bars that are forced against the cancellous and cortical bone and prevent rotation. The entire length of the nail provides frictional contact. The fact that no locking screws are needed reduces radiological exposure for both theatre staff and patients and shortens operation times.

Ten patients had fractures in highly osteoporotic humeri, four had metastases and one a pseudarthrosis after plate fixation. There were no remarkable intra-operative or postoperative complications. Postoperative radiographic evaluation demonstrated correct axial alignment in all cases. No revisions were required and there were no intraoperative radial nerve injuries. The operative time was around 30 minutes. All fractures were stable enough to permit mobilisation of the arm and all united.