title: Humeral shaft fractures treated with antegrade intramedullary nailing: what are the consequences for the rotator cuff?
abstract: OBJECTIVE
  The purpose of this study was to investigate the clinical and sonographic impact on the rotator cuff (RC) of the use of the anterolateral approach for nailing.
  
  
  METHODS
  A retrospective cohort of 48 patients treated for humeral diaphyseal fractures at the University Hospital of Parma between 2007 and 2011 was analysed. Inclusion criteria were (1) acute humeral shaft fractures treated with T2-proximal humeral nail (PHN) and (2) a minimum follow-up of one year. Exclusion criteria were (1) history of proximal and metaphyseal humeral fractures, (2) pathological fractures or open fractures of the humerus, and (3) RC lesions. Clinical assessment using the Constant score, simple shoulder test and through shoulder examination tests was carried out. The sonographic study investigated the integrity of the RC.
  
  
  RESULTS
  Mean score on Constant's scale was 78.21 points, with most patients achieving a good result (79% obtained more than 65 points). One patient had a limited functional outcome (Constant's score of 49 points). The sonographic findings described for supraspinatus tendon were a partial ruptures of less than 30 mm in three patients and a complete tendon rupture in one case.
  
  
  CONCLUSIONS
  The results of this study suggest that the use of the anterolateral approach for antegrade humeral nailing ensures a good functional result with no significant clinical-sonographic impact on the rotator cuff and a satisfactory long term clinical outcome.
authors.affiliation: Orthopaedic and Traumatologic Department, University Hospital of Parma, Via Gramsci 14, Parma, Italy.
authors.forename: Michele Arcangelo
authors.initials: MA
authors.lastname: Verdano
authors.forename: Andrea
authors.initials: A
authors.lastname: Pellegrini
authors.forename: Paolo
authors.initials: P
authors.lastname: Schiavi
authors.forename: Luca
authors.initials: L
authors.lastname: Somenzi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Concari
authors.forename: Francesco
authors.initials: F
authors.lastname: Ceccarelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging*; D012421:Rupture / Q000000981:diagnostic imaging / Q000453:epidemiology; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult