Rotator cuff integrity and shoulder function after intra-medullary humerus nailing.

Area of Science:

• Orthopedic surgery
• Traumatology
• Sports medicine

Background:

• Antegrade percutaneous intra-medullary nailing (IMN) for humerus fractures has a historically poor reputation.
• Assessing rotator cuff integrity and shoulder function post-IMN is crucial for treatment evaluation.

Purpose of the Study:

• To evaluate rotator cuff integrity and shoulder function after intra-medullary nailing (IMN) for humerus fractures using third-generation nails.
• To compare the outcomes of third-generation nails with earlier generations regarding tendon integrity and shoulder function.

Main Methods:

• A retrospective study of 40 patients with displaced humeral fractures treated with third-generation IMN.
• Clinical, radiological, and ultrasound follow-up was conducted at a mean of 8 months, with 22 patients undergoing postoperative CT scans.

Main Results:

• Supraspinatus tendon lesions occurred in 12.5% of patients, were generally asymptomatic, and showed no significant functional impact.
• Long head of biceps (LHB) tendinopathy affected 20% of patients, was symptomatic, and associated with significantly impaired functional scores.
• Technical errors, including nail positioning and screw placement, were identified in 4 cases, contributing to LHB issues.

Conclusions:

• Third-generation humeral nails are associated with a low prevalence of asymptomatic supraspinatus tendon lesions.
• Symptomatic LHB tendinopathy is a frequent complication, often linked to technical errors in nail placement or screw length.
• While rotator cuff integrity is largely preserved, careful surgical technique is essential to minimize LHB-related complications.