title: Microcirculatory sequelae of the rotator cuff after antegrade nailing in proximal humerus fracture.
abstract: BACKGROUND
  Antegrade nailing allows a stable fixation and, thus, an early functional after treatment in proximal humerus fractures. Since the surgical procedure in antegrade humeral nailing requires a split of the supraspinatus tendon, the question arises whether the surgical approach causes microcirculatory dysfunction of the tendon.
  
  
  METHODS
  A total of 15 consecutive patients suffering from proximal humerus fractures were enrolled. During the implantation of an antegrade humerus nail, microvascular perfusion of the supraspinatus tendon was directly visualized after the exposition and stabilization of the fracture using the OPS-imaging technique.
  
  
  RESULTS
  Immediately after exposure, the nutritive perfusion showed physiological values of tendon microcirculation. After implanting antegrade humeral nails, the perfusion of the supraspinatus tendon reduced markedly. Capillary width was unaffected by the surgical procedure.
  
  
  CONCLUSIONS
  The trauma leading to proximal humerus fracture causes no fundamental impairment of nutritive perfusion of the rotator cuff. Whereas the implantation of an antegrade humerus nail, which necessarily includes a splitting of the rotator cuff, nearly halves the functional capillary density of the supraspinatus tendon. Even though this effect seems to be reversible, the surgical dissection of the supraspinatus tendon should be performed in a soft tissue sparing way.
authors.affiliation: Department of Trauma and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany. philip.gierer@med.uni-rostock.de
authors.forename: Philip
authors.initials: P
authors.lastname: Gierer
authors.forename: Martin
authors.initials: M
authors.lastname: Scholz
authors.forename: Markus
authors.initials: M
authors.lastname: Beck
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Schaser
authors.forename: Brigitte
authors.initials: B
authors.lastname: Vollmar
authors.forename: Thomas
authors.initials: T
authors.lastname: Mittlmeier
authors.forename: Georg
authors.initials: G
authors.lastname: Gradl
mesh_terms: D000368:Aged; D001858:Bone Nails; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D017006:Rotator Cuff / Q000098:blood supply*; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome