Antegrade Humeral Nailing Through the Rotator Cuff Interval: A New Entry Portal

The conventional approach for antegrade intramedullary nailing (AIN) of humerus fractures is associated with persistent pain and compromised shoulder function. Damage to the critical hypovascular zone of the rotator cuff near its insertion on the humerus and/or irritation of the subacromial space by prominent hardware are the factors believed to be responsible for poor shoulder function after AIN of the humerus. This study describes a new entry portal through the rotator interval that minimizes iatrogenic damage to the rotator cuff at its insertion. This approach offers a solution for the disappointing postoperative shoulder function and pain scores associated with conventional antegrade nailing techniques. This study consisted of 33 patients with 34 humeral fractures followed for an average of 34 months. The overall satisfaction rate was more than 90%, according to the ASES (American Shoulder and Elbow Society) score. The mean Constant Score was 84 (SD, 14; range, 17 to 98), and primary bone union was achieved in 32 of the 34 cases.