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. Antegrade intramedullary nailing (AIN) has been recently recognized as a valid option and a reliable alternative to locking plate fixation for humeral fractures, and is more in accord with the principles of minimal invasive surgery. 1) In fact, AIN has several advantages, that is, better rotational stability, a good lever arm effect, less soft tissue damage at the fracture site, shorter operative time, lower infection rates, and earlier functional recovery. However, it is also associated with persistent shoulder pain and an unsatisfactory outcome rate of 20% to 40%, in some cases shoulder function does not return to normal even after nail removal. 1) Complications associated with poor shoulder function after antegrade intramedullary nail insertion in the humerus include, rotator cuff damage near the point of insertion, impingement or superior protrusion of the nail in the subacromial space, nail loosening, screw back-out, and joint stiffness.
1)Here, we present a case of a non-healed longitudinal tear of the supraspinatus tendon at the insertion point of an intramedullary humeral nail with severe secondary impingement, its clinical results after cuff repair, and subacromial decompression. The patient provided informed consent for the publication of his case information in the form of a case report.
Case ReportA 29-year-old man presented complaining of a 4-year history of right shoulder pain and snapping, especially during forward elevation and abduction of the right shoulder. The patient sustained a mid-shaft fracture of the right humerus during a fall from a height of 8 m while working in July 2004. At that time, he was treated at a local hospital immediately, although