Clinical and Sonographic Assessment of Rotator Cuff Damage During Antegrade Humeral Nailing

Purpose One of the most controversial points about antegrade humeral nailing is that of potential iatrogenic injuries to the rotator cuff. The purpose of this paper is to determine the clinical and sonographic impact associated to the use of the anterolateral approach. Materials and methods Transversal study of a retrospective cohort of 23 patients operated on for humeral diaphyseal fractures at the 12 de Octubre Hospital between 1998 and 2004. Inclusion criteria Acute humeral shaft fractures treated by means of antegrade nailing. No age threshold was imposed; minimum follow-up was one year. Exclusion criteria Patients with an associated rheumatic pathology were excluded as well as those that had suffered a prior glenohumeral traumatic event or a proximal humeral fracture. Clinical assessment was conducted with Constant's scale and the sonographic study used the contralateral shoulder as control. Results Mean score on Contant's scale was 82 points (range: 49-99), with most patients achieving a good result, i.e. 80% obtained more than 65 points. The only sonographic findings described were a few hyperechogenic lines in 4 patients, which were interpreted as partial ruptures of less than 30 mm. These patients had an acceptable functional outcome, with a score of more than 70 points on Constant's scale. Conclusions The results of this study suggest that the use of the anterolateral approach for antegrade humeral nailing, provided that there is careful dissection and posterior suturing of the rotator cuff, as well as a sufficiently medialized entry point on the humeral head, ensures a good functional result with no significant clinical-sonographic impact.