Abstract
Introduction
Antegrade nailing allows a stable fixation and, thus, an early functional after treatment in proximal humerus fractures. Since the surgical procedure in antegrade humeral nailing requires a split of the supraspinatus tendon, the question arises whether the surgical approach causes microcirculatory dysfunction of the tendon.
Materials and methods
A total of 15 consecutive patients suffering from proximal humerus fractures were enrolled. During the implantation of an antegrade humerus nail, microvascular perfusion of the supraspinatus tendon was directly visualized after the exposition and stabilization of the fracture using the OPS-imaging technique.
Results
Immediately after exposure, the nutritive perfusion showed physiological values of tendon microcirculation. After implanting antegrade humeral nails, the perfusion of the supraspinatus tendon reduced markedly. Capillary width was unaffected by the surgical procedure.
Conclusion
The trauma leading to proximal humerus fracture causes no fundamental impairment of nutritive perfusion of the rotator cuff. Whereas the implantation of an antegrade humerus nail, which necessarily includes a splitting of the rotator cuff, nearly halves the functional capillary density of the supraspinatus tendon. Even though this effect seems to be reversible, the surgical dissection of the supraspinatus tendon should be performed in a soft tissue sparing way.
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References
Adedapo AO, Ikpeme JO (2001) The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury 32:115–121
Biberthaler P, Langer S, Luchting B, Khandoga A, Messmer K (2001) In vivo assessment of colon microcirculation: comparison of the new OPS imaging technique with intravital microscopy. Eur J Med Res 6:525–534
Biberthaler P, Wiedemann E, Nerlich A, Kettler M, Mussack T, Deckelmann S, Mutschler W (2003) Microcirculation associated with degenerative rotator cuff lesions. In vivo assessment with orthogonal polarization spectral imaging during arthroscopy of the shoulder. J Bone Joint Surg (AM) 85A:475–480
Frangen TM, Dudda M, Martin D, Arens S, Greif S, Muhr G, Kalicke T (2007) Proximal humeral fractures with angle-stable plate osteosynthesis-is everything better now? Zentralbl Chir 132:60–69
Gallo RA, Sciulli R, Daffner RH, Altman DT, Altman GT (2007) Defining the relationship between rotator cuff injury and proximal humerus fractures. Clin Orthop Relat Res 458:70–77
Gierer P, Mittlmeier T, Bordel R, Schaser KD, Gradl G, Vollmar B (2005) Selective cyclooxygenase-2 inhibition reverses microcirculatory and inflammatory sequelae of closed soft-tissue trauma in an animal model. J Bone Joint Surg (AM) 87A:153–160
Groner W, Winkelman JW, Harris AG, Ince C, Bouma GJ, Messmer K, Nadeau RG (1999) Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med 5:1209–1212
Kettler M, Biberthaler P, Braunstein V, Zeiler C, Kroetz M, Mutschler W (2006) Treatment of proximal humeral fractures with the PHILOS angular stable plate: presentation of 225 cases of dislocated fractures. Unfallchirurg 109:1032–1040
Khodadadyan-Klostermann C, Raschke M, Fontes R, Melcher I, Sossan A, Bagchi K, Haas N (2002) Treatment of complex proximal humeral fractures with minimally invasive fixation of the humeral head combined with flexible intramedullary wire fixation—introduction of a new treatment concept. Langenbecks Arch Surg 387:153–160
Mathews J, Lobenhofer P (2004) Results of intramedullary nailing of unstable proximal humeral fractures in geriatric patients with a new antegrade nail system. Unfallchirurg 107:372–380
Mittlmeier T, Kääb MJ, Stedtfeld H-W, Arndt D, Hopfenmüller W, Gradl G (2006) Winkelstabiler Verriegelungsmarknagel versus winkelstabile Platte bei der Humeruskopffraktur. Funktionelle Resultate einer Matched-pairs-Studie. German Medical Science Doc W.4.8:6–592
Mittlmeier T, Stedtfeld HW, Ewert A, Beck M, Frosch B, Gradl G (2003) Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon PH). J Bone Joint Surg (AM) 85A(Suppl 4):136–146
Mittlmeier T, Vollmar B, Menger MD, Schewior L, Raschke M, Schaser KD (2003) Small volume hypertonic hydroxyethyl starch reduces acute microvascular dysfunction after closed soft-tissue trauma. J Bone Joint Surg (Br) 85B:126–132
Parsch D, Wittner B (2000) Prevalence of rotator cuff defects in dislocated fractures of the humerus head in elderly patients. Unfallchirurg 103:945–948
Schaser KD, Vollmar B, Menger MD, Schewior L, Kroppenstedt SN, Raschke M, Lubbe AS, Haas NP, Mittlmeier T (1999) In vivo analysis of microcirculation following closed soft-tissue injury. J Orthop Res 17:678–685
Stedtfeld HW, Attmanspacher W, Thaler K, Frosch B (2003) Fixation of humeral head fractures with antegrade intramedullary nailing. Zentralbl Chir 128:6–11
von Dobschuetz E, Biberthaler P, Mussack T, Langer S, Messmer K, Hoffmann T (2003) Noninvasive in vivo assessment of the pancreatic microcirculation: orthogonal polarization spectral imaging. Pancreas 26:139–143
Wijgman AJ, Roolker W, Patt TW, Raaymakers EL, Marti RK (2002) Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Join Surg 84A:1919–1925
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Gierer, P., Scholz, M., Beck, M. et al. Microcirculatory sequelae of the rotator cuff after antegrade nailing in proximal humerus fracture. Arch Orthop Trauma Surg 130, 687–691 (2010). https://doi.org/10.1007/s00402-009-0956-z
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DOI: https://doi.org/10.1007/s00402-009-0956-z