Rotator cuff tears and mid-term shoulder outcomes after intramedullary nail fixation for humeral shaft fracture: a minimum 5-year follow-up study

Abstract

Background Antegrade intramedullary nail fixation for humeral shaft fractures yields satisfactory union rates. However, one concern is damage to the rotator cuff during nail insertion, which may affect long-term outcomes. The effect of rotator cuff lesion on mid- and long-term shoulder outcomes remains unknown. This study aimed to investigate the incidence of rotator cuff tears 5 years or more after intramedullary nailing for humeral shaft fractures, and to determine the impact of postoperative rotator cuff tears on mid-term outcomes. Methods We retrospectively identified 22 patients who underwent antegrade intramedullary nail fixation for traumatic humeral shaft fractures and received follow-up for at least 5 years postoperatively. We divided the patients into those without tears and those with partial or complete tears, diagnosed using ultrasonography. We compared the functional and radiological shoulder outcomes between the two groups. Results Of 22 patients, nine had partial or complete supraspinatus tears at a mean follow-up of 7.5 years postoperatively. The incidence of acromial spurs was significantly higher in patients with partial or complete tears than in those without tears (P = 0.002). There were no significant differences in age and gender-adjusted Constant score, and American Shoulder and Elbow Surgeon score between the two groups. Conclusions Our results showed that 41% of patients developed partial or complete supraspinatus tendon tears in the mid-term. Postoperative rotator cuff tears were significantly associated with the formation of acromial spurs; however, it had no significant effect on shoulder functional outcomes.