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KMID : 1195520130060010001
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Journal of Korean Orthopaedic Ultrasound Society
2013 Volume.6 No. 1 p.1 ~ p.9
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Clinical and Radiographic Outcome of Shoulder Function after Unreamed Antegrade Intramedullary Nailing for Humerus Fracture: Ultrasonographic Evaluation for Rotator Cuff Integrity
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Baek Seung-Hoon
Choi Chang-Hyuk
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Abstract
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Purpose: The purpose is to perform objective evaluation for rotator cuff using ultrasonography and validate factors
influencing cuff integrity as well as efficacy of follow-up ultrasonography after unreamed antegrade intramedullary nailing
for humerus fracture.
Materials and Methods: Seventeen patients with an average age of 55.7±18.6 years underwent antegrade
intramedullary nailing for humerus fracture and follow-up ultrasonography of shoulder joint. Mean follow-up period was
43.5±32.2 months. Intraoperative evaluation for preoperative cuff tear was performed, of which four cuffs were repaired
by single row repair technique. Clinical evaluation included visual analogue scale (VAS), range of motion, Korean
Shoulder Scoring System (KSS) and American Shoulder and Elbow Society (ASES) score. Ultrasonographic evaluation
was performed on cuff integrity and protrusion of proximal nail tip as well. Radiographic evaluation included time to union,
protrusion of proximal nail tip and migration of proximal interlocking screw which could affect shoulder joint function.
Results: Mean VAS at last follow-up was 1.65±1.84 points. Range of motion showed forward flexion of 137.0±
33.5。, external rotation of 43.5±12.7。and internal rotation of 16.4±2.0。while KSS score and ASES score were
79.6±20.7 and 83.7±17.0 points, respectively. Bone union was demonstrated in all cases and average time to union
was 3.4±1.3 months. Migration of proximal interlocking screw was shown in 6 cases (35%). On ultrasonographic
evaluation, there were normal in 8 (47%), weaving in 4 (24%), partial tear in 5 cases (29%), but no complete tear.
Protrusion of proximal nail tip was demonstrated in 8 cases (47%) on plain radiographs whereas in 11 cases (65%)
on ultrasonography and was associated with increasing age (p=0.038). Ultrasonographic weaving and partial tear
was associated with protrusion of proximal nail tip (p=006), but not with repair of preoperative tear (p>0.05).
Conclusion: Because weaving and partial tear on ultrasonography originated from protrusion of proximal nail tip, careful insertion of nail and meticulous repair of cuff during operation lead to stable fixation with satisfactory recovery
of shoulder function follow-up ultrasonography can be a useful tool for evaluating protrusion of nail tip and rotator cuff
tear, of which diagnosis is difficult on plain X-ray after antegrade intramedullary nailing for humerus fracture.
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KEYWORD
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Humerus, Fracture, Intramedullary nail, Ultrasonography, Rotator cuff tear, Nail tip protrusion
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