Rotator cuff alterations resulting from humeral head fractures

Most complex humeral head fractures are associated with a longitudinal tear of the rotator cuff. Reconstruction of this tear is frequently omitted from surgical reduction and fixation procedures. In 48 patients treated by surgery or by conservative means, we investigated the relationship between rotator cuff integrity and the functional results. The rotator cuff was assessed by ultrasonography, the functional results by the Constant Score. Common signs of rotator cuff alterations were partial or complete atrophy. In all patients affected, a longitudinal defect located at the rotator interval was detected. A classification of rotator cuff alterations resulting from humeral head fractures was introduced, yielding three categories: none, moderate, or severe. In three patients, sonographic results were confirmed by magnetic resonance imaging (MRI). Rotator cuff alterations were often associated with displaced consolidation results. Furthermore, the integrity of the rotator cuff significantly correlated with the function achieved. The results support the need for a careful rotator cuff repair in order to optimise treatment results.