Sonographic Evaluation of Rotator Cuff Injury in Antegrade Locked Nailing for Humeral Fractures

Background:

With improved implant design and surgical technique, operative treatment of humeral shaft fractures increasingly has become accepted. Such treatment offers several advantages. The rigidly fixed, fractured limb can be used early without external support, and the patient can sleep, as normal, in the supine position. In addition, the angular deformity often seen with conservative treatment effectively is prevented. Although plate osteosynthesis can afford a rigid fixation and good functional recovery, its disadvantages have been reported. By comparison, locked nailing, which provides sufficient fixation stability and prevents slipout of the nail, offers the advantages of less soft tissue injury, a lower infection rate, and no need for radial nerve extrication. Locked nailing is preferred especially for open fractures, comminuted fractures, pathologic fractures, and fractures associated with osteoporosis. The use of Seidel locked nails with spreading fins can be complicated by inadequate fixation, intraoperative bone comminution, and unsatisfactory recovery of shoulder function. Biomechanically, locked nails with transfixing locking screws allow much better rotational control of the distal fragment than do Seidel nails. Most rigid humeral nails are inserted antegrade, but a disadvantage to antegrade nailing has been the risk of shoulder function impairment, which partially negates the advantages of closed nailing and of loadsharing mechanical properties. The disadvantages of retrograde nailing are potential risk of elbow joint injury and nonlinear entry portal of nailing.

Gaullier O et al did a study of 23 cases with rotator cuff evaluation in 1999. Only humeral diaphyseal fractures were enrolled. Fracture type classification was according to AO. Clinical shoulder assessment was carried out using the Constant score. Treatment was Seidel intramedullary locked nailing.

Seidel intramedullary locked nailing was too big for patients in Taiwan. Compared to patients in western countries, our patients had small stature. The humeral locked nail, invented by Jinn Lin, provided a proper treatment option for humeral fractures in Asian people.

Although H-L nail has the advantages of minimal tissue trauma, it still has the possibility of rotator cuff injury. The purpose of our study is to evaluate rotator cuff injury in antegrade humeral locked nailing for humeral fractures by means of sonographic evaluation and shoulder functional examination.