Ultrasound Evaluation of the Rotator Cuff after Osteosynthesis of Humeral Shaft Fractures with Interlocking Intramedullary NailA Prospective Interventional Study

Abstract

Introduction: Antegrade intramedullary nailing in humeral shaft fracture allows a stable fixation with satisfactory outcomes. However, shoulder impairment remains an important complication of intramedullary nailing. The procedure involving the splitting of supraspinatus tendon to expose humeral head for nail insertion has been attributed for it, even though it is followed by the repair of the tendon. Aim: To evaluate rotator cuff integrity with Ultrasound (USG) in patients who underwent humeral fracture fixation with an intramedullary interlocking nail and to evaluate the clinical outcome of the shoulder joint in patients with and without rupture of the rotator cuff using constant murley and QuickDASH scores. Materials and Methods: This prospective interventional study was conducted in the Department of Orthopaedics of AJ Institute of Medical Sciences, Mangaluru, India, from August 2018 to September 2020 in which 20 adult patients with acute humeral shaft fractures were treated with closed intramedullary nailing in antegrade manner. Patients were followed-up for six months clinically and radiologically. The USG evaluation of rotator cuff was done at six months follow-up, along with clinical evaluation using constant Murley and QuickDASH scores. Association between variables was analysed by using Chi-square test for categorical variables. Unpaired t-test was used to compare the mean of quantitative variables. The level of significance was set at 0.05. Data were entered into Microsoft excel (Windows 7; Version 2007) and analyses were done using the Statistical Package for Social Sciences (SPSS) for Windows software (version 22.0; SPSS Inc, Chicago). Results: At six months follow-up, patients were evaluated by USG showing ruptured supraspinatus tendon in 3 (15%) of the study patients. The results by constant murley score were 76.50±12.61 for the entire series, 77.82±12.75 for patients without rotator cuff rupture, and 69±10.53 for patients with partial rupture of the rotator cuff, with no statistical difference (p=0.275). QuickDASH scores were 9.90±7.69 for the entire series, better in the group without rupture of the rotator cuff (9.41±7.92 versus 12.70±6.84) but without statistically significant difference (p=0.510). Conclusion: The functional outcome of the shoulder joint is satisfactory and is not influenced by the presence or absence of a rotator cuff tear following the procedure.