Fig. 5

Male patient, 57 years, sustained a diaphyseal spiral fracture after a fall from stairs (1a). Three intraoperative views with the image intensifier: insertion point and direction was determined using a 2.0 mm Kirschner wire. After the feasibility has been verified a cannulated awl is used to perforate the supraspinatus tendon and the articular surface. With the awl in situ the Kirschner is removed and replaced by a long guide wire which then directs the nail (1b). After stabilisation a diagnostic arthroscopy is performed to document the perforation of the rotator cuff, the appropriate depth of the nail and to exclude concomitant intraarticular lesions (1c). Five months after surgery a CT with intraarticular application of contrast medium was performed; a leakage or lesion to the rotator cuff was excluded (1d). Bony consolidation at 6 months after surgery (1e)