- Volume 18 Issue 1
Longitudinal Supraspinatus Tear Associated with Antegrade Humeral Intramedullary Nailing: A Case Report and Literature Review with Focus Placed on Nail Entry Point
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Shon, Min Soo;Bang, Tae Jung;Yoo, Jae Chul
- 투고 : 2015.02.02
- 심사 : 2015.02.11
- 발행 : 2015.03.30
Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.
Rotator cuff;Complications;Intramedullary nailing;Arthroscopy
- Zhu Y, Lu Y, Shen J, Zhang J, Jiang C. Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures: a prospective randomized trial with a minimum of three years of follow-up. J Bone Joint Surg Am. 2011;93(2):159-68. https://doi.org/10.2106/JBJS.J.00155
- Stedtfeld HW, Mittlmeier T. Fixation of proximal humeral fractures with an intramedullary nail: Tipps and Tricks. Eur J Trauma Emerg Surg. 2007;33(4):367-74. https://doi.org/10.1007/s00068-007-7094-5
- Gierer P, Scholz M, Beck M, et al. Microcirculatory sequelae of the rotator cuff after antegrade nailing in proximal humerus fracture. Arch Orthop Trauma Surg. 2010;130(5):687-91. https://doi.org/10.1007/s00402-009-0956-z
- Robinson CM, Bell KM, Court-Brown CM, McQueen MM. Locked nailing of humeral shaft fractures. Experience in Edinburgh over a two-year period. J Bone Joint Surg Br. 1992;74(4):558-62.
- Garcia-Bogalo R, Larrainzar-Garijo R, Diez-Nicolas E, Llanos-Alcazar LF. Clinical and sonographic assessment of rotator cuff damage during antegrade humeral nailing. Rev Chir Orthop. 2008;52(1):2-8.
- Hatzidakis AM, Shevlin MJ, Fenton DL, Curran-Everett D, Nowinski RJ, Fehringer EV. Angular-stable locked intramedullary nailing of two-part surgical neck fractures of the proximal part of the humerus. A multicenter retrospective observational study. J Bone Joint Surg Am. 2011;93(23):2172-9. https://doi.org/10.2106/JBJS.J.00754
- Park JY, Pandher DS, Chun JY, Md ST. Antegrade humeral nailing through the rotator cuff interval: a new entry portal. J Orthop Trauma. 2008;22(6):419-25. https://doi.org/10.1097/BOT.0b013e318173f751
- Knierim AE, Bollinger AJ, Wirth MA, Fehringer EV. Short, locked humeral nailing via Neviaser portal: an anatomic study. J Orthop Trauma. 2013;27(2):63-7. https://doi.org/10.1097/BOT.0b013e31825194ad
- Lill H, Katthagen C, Hertel A, Gille J, Voigt C. All-arthroscopic intramedullary nailing of 2-and 3-part proximal humeral fractures: a new arthroscopic technique and preliminary results. Arch Orthop Trauma Surg. 2012;132(5):641-7. https://doi.org/10.1007/s00402-011-1430-2
- Mihara K, Tsutsui H, Suzuki K, Makiuchi D, Nishinaka N, Yamaguchi K. New intramedullary nail for the surgical neck fracture of the proximal humerus in elderly patients. J Orthop Sci. 2008;13(1):56-61. https://doi.org/10.1007/s00776-007-1193-3