title: Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation.
abstract: BACKGROUND
  Antegrade intramedullary (IM) nailing of humeral shaft fractures is reported to cause shoulder joint impairment. This retrospective study compared shoulder joint symptoms, range of motion (ROM), and isometric strength after antegrade IM nailing and dynamic compression (DC) plating of humeral shaft fractures.
  
  
  METHODS
  We compared 29 patients with DC plating and 44 with antegrade IM nailing of their humeral shaft fractures. Shoulder pain, L'Insalata and Constant scores, shoulder joint ROM and isometric shoulder strengths were measured after mean follow-up of 6.2 (1-15) years (DC plating) and 5.5 (2-10) years (IM nailing).
  
  
  RESULTS
  Patients had nonsignificantly more shoulder pain after IM nailing than after DC plating. Shoulder scores and isometric strength measurements showed no difference between the groups. Flexion was significantly better after DC plating, but none of the other ROM parameters differed between the groups. The shoulder scores and all ROM and strength parameters of the injured side were significantly lower than on the uninjured side in both groups.
  
  
  CONCLUSIONS
  Shoulder joint ROM and strength does not recover to normal after humeral shaft fracture. Antegrade IM nailing if performed properly is not responsible for shoulder joint impairment.
authors.affiliation: Department of Surgery, Division of Orthopaedic and Trauma Surgery, University Hospital, Kajaanintie 52, 90220 Oulu, Finland. Tapio.Flinkkila@oulu.fi
authors.forename: Tapio
authors.initials: T
authors.lastname: Flinkkilä
authors.forename: Pekka
authors.initials: P
authors.lastname: Hyvönen
authors.forename: Pertti
authors.initials: P
authors.lastname: Siira
authors.forename: Martti
authors.initials: M
authors.lastname: Hämäläinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D005594:Fracture Fixation, Intramedullary; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology*