Surgical Treatment of Humeral Shaft Fractures by Arthroscopyassisted Intramedullary Nail Fixation

Abstract

Objective: Humeral shaft fractures face with controversies about the entry site of intramedullary nailing (IMN) due to its potentialcomplications. We aimed to evaluate feasibility of arthroscopy-assisted intramedullary nail fixation for the management of these fractureswith respect to its mid-term clinical and functional outcomes, complication rates of nail entry site, and fluoroscopy duration.Methods: We examined medical data of 21 patients who underwent arthroscopy-assisted IMN after closed reduction upon diagnosis ofhumeral shaft fracture. Analyzed parameters included duration of anesthesia, surgery, fluoroscopy, preoperative hospitalization, and union;surgical complication rates; and the degree of lateralization between ideal and applied nail entry site, as measured by shoulder computedtomography scans. Shoulder functions were assessed by Constant and American Shoulder and Elbow Surgeons (ASES) scoring.Results: Patients were found to be followed up for a mean of 22.8±4.76 months. The mean duration of surgery was 56.9±14.27 minutes. Themean fluoroscopy time was detected as 1.63±0.49 minutes. Distal locking was performed without fluoroscopy (electromagnetic targeting orinternal locking nail) in 15 patients and with free hand method under fluoroscopy in six patients. The mean duration of fluoroscopy in thesetechniques were 1.47±0.41 minutes and 1.91±0.52 minutes, respectively. No patient was found to have subacromial impingement syndrome.The mean lateralization of nail entry sites was measured as 0.61±0.73 mm. The mean degree of varus was 2.38±1.18. The mean ASES andConstant scores were found as 89±2.81 and 90±4.59 points,respectively. Excellent/good functional outcomes had been reported by 90.5% ofthe study population.Conclusion: Arthroscopy-assisted technique may minimize rotator cuff injury and thereby may provide satisfactory outcomes in postoperativeshoulder functions. This technique may be a feasible and safe option associated with reduced entry site complications and potentially lessexposure to radiation from shorter use of fluoroscopy