Microcirculatory sequelae of the rotator cuff after antegrade nailing in proximal humerus fracture.
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.
Gierer
Philip
P
Department of Trauma and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany. philip.gierer@med.uni-rostock.de
Scholz
Martin
M
Beck
Markus
M
Schaser
Klaus D
KD
Vollmar
Brigitte
B
Mittlmeier
Thomas
T
Gradl
Georg
G
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