Abstract:

Objective: Humeral shaft fractures face with controversies about the entry site of intramedullary nailing (IMN) due to its potential complications. We aimed to evaluate feasibility of arthroscopy-assisted intramedullary nail fixation for the management of these fractures with 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 of humeral 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 computed tomography 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. The mean fluoroscopy time was detected as 1.63±0.49 minutes. Distal locking was performed without fluoroscopy (electromagnetic targeting or internal locking nail) in 15 patients and with free hand method under fluoroscopy in six patients. The mean duration of fluoroscopy in these techniques 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 and Constant scores were found as 89±2.81 and 90±4.59 points,respectively. Excellent/good functional outcomes had been reported by 90.5% of the study population. Conclusion: Arthroscopy-assisted technique may minimize rotator cuff injury and thereby may provide satisfactory outcomes in postoperative shoulder functions. This technique may be a feasible and safe option associated with reduced entry site complications and potentially less exposure to radiation from shorter use of fluoroscopy.

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