Comparison between anterolateral standard and percutaneous antero-acromial approach in humeral intramedullary nailing (IMN). A radiological, functional, and ultrasound rotator cuff evaluation prospective study.

PURPOSE

The aim of this study was to evaluate the radiological-functional outcomes and rotator cuff (RC) status following humeral intramedullary nailing (IMN), comparing the anterolateral standard approach (group 1) and the percutaneous antero-acromial approach (group 2).

METHODS

This observational prospective monocentric study was conducted from August 2021 to March 2023. Inclusion criteria included: two-parts proximal (surgical neck) and diaphyseal Humeral fractures treated with IMN; 12-month follow-up; age between 18 and 85 years; good performance status (excluding neurologic deficits or mental disorders). Evaluations included RC status via ultrasound, Constant, DASH, and SPADI scores, as well as fracture healing times. A T-test was used or statistical analysis.

RESULTS

Sixty-one patients were enrolled during the study period (34 in group 1; 27 in group 2). The mean bone healing time resulted 2.9 ± 0.5 months in group 1 and 2.4 ± 0.7 months in group 2, with a statistically significant reduction of 17% in favor of group 2 (p < 0.05). No significant differences were found in the Constant scores at 6 and 12 months of follow-up; however, significant differences were observed in DASH and SPADI scores (p < 0.05). Supraspinatus tears were detected in both groups: 6 in Group 1 (2 full-thickness and 4 partial) localized at the footprint, and 4 in Group 2 (1 full-thickness and 3 partial) assessed medially in the musculotendinous portion.

CONCLUSION

Intramedullary nailing with a percutaneous approach proved to be a minimally invasive technique with better functional outcomes and shorter fracture healing times. The impact on the RC was comparable to the standard approach.