[Treatment of fresh humeral diaphysis fractures by Seidel intramedullary locked nailing. A study of 23 initial cases after 2.5 years with rotator cuff evaluation]

O Gaullier, L Rebaï, J L Dunaud, M Moughabghab, S Benaissa
Revue de Chirurgie Orthopédique et Réparatrice de L'appareil Moteur 1999, 85 (4): 349-61

PURPOSE OF THE STUDY: The Seidel intramedullary locking nail is one of the alternative methods for operative treatment of humeral shaft fractures. Short follow-up demonstrated persistent pain and stiffness at the shoulder joint. The aims of this retrospective study were first to evaluate results with attention to operative technique, consolidation rate and postoperative complications. Second we studied rotator cuff healing in our first patients.

MATERIAL AND METHODS: Twenty-five acute diaphyseal fractures were treated between May 91 and Dec 94. We reviewed personally 23 patients with a mean follow-up of 33 months (range 22-66). The dominant fracture type according to AO was type A. Clinical shoulder assessment was carried out using the Constant score. Isometric strength was recorded in both shoulders with a hand-held dynamometer in abduction, external and internal rotation. Sonographic evaluation of the rotator cuff was performed using a 7.5 MHz linear array transducer in all 23 patients.

RESULTS: All but one fracture healed at an average of two months. Impingement was observed in three patients but pain relief and normal shoulder motion have been reached after nail removal. Infection occurred in one patient but final result was good. Constant score averaged 78.7 (range 51-94.2) classifying the result in all but two patients as excellent or good. Compared with the external and internal rotations, strength was significantly reduced in abduction but reached 83.5 per cent of the opposite shoulder. No statistical differences were found in relation with age, gender and side. Compared with the contralateral shoulder, rotator cuff evaluation with sonography was considered as normal in 18 patients. Calcium deposits of the cuff were noticed in the infected patient. In three cases sonography detected hyperechoic line considered as scar in the supraspinatus tendon without any partial or full-thickness tear.

DISCUSSION AND CONCLUSION: A median starting point avoids the avascular area and gives a straight access to the medullary canal. This study demonstrates that using this entry portal and a reliable technique antegrade nailing of the humerus does not compromise rotator cuff healing and shoulder function. Technical errors lead to poor or fair results but despite this learning curve, Seidel nail when operative treatment is indicated, is a good choice. Attention must be paid to patients with clinical history of impingement or rotator cuff tendinopathy.

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