Lazaro Mesa, Christian M Schmidt, Reed Andrews, Mitchel John, Khaled Abdelghany, Maykel Dolorit, Mir Ibrahim Sajid, David Watson, Hassan R Mir
{"title":"Humeral Intramedullary Nailing Utilizing the Minimally Invasive Rotator-Interval Technique (MIR-IT) Improves Shoulder PROMs.","authors":"Lazaro Mesa, Christian M Schmidt, Reed Andrews, Mitchel John, Khaled Abdelghany, Maykel Dolorit, Mir Ibrahim Sajid, David Watson, Hassan R Mir","doi":"10.1097/BOT.0000000000002993","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To assess whether patients treated with a Minimally Invasive Rotator-Interval Technique (MIR-IT) versus the traditional technique of splitting the rotator cuff (RTCS) for intramedullary nailing of humeral shaft fractures resulted in comparable post-operative clinical and patient-reported outcomes (PROM).</p><p><strong>Methods: </strong>Design: Retrospective Cohort Study.</p><p><strong>Setting: </strong>Level 1 Trauma Center.</p><p><strong>Patient selection criteria: </strong>Patients >18yo with humeral shaft fractures (AO/OTA 12A-C) treated with IMN between 2015 and 2022.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was differences in PROMs (ASES, Quick DASH, and Oxford Shoulder Score) between the MIR-IT and RTCS techniques. Secondary outcome measures included differences in rates of nonunion, superficial and deep surgical infections, wound dehiscence and iatrogenic nerve palsy between the two techniques.</p><p><strong>Results: </strong>Seventy-one patients underwent humeral IMN (MIR-IT - 39; RTCS - 32). Fifty-five patients (MIR-IT- 30; RTCS-25) had radiographic and clinical follow up to union. Mean follow up was 7.5 months (range: 3.1-16.8 months). Patients did not vary significantly with regards to age (MIR-IT: 54.4 ± 22.4; RTCS: 55.1 ± 18.5 years, p=0.896), and gender (Males- MIR-IT: 46.7%, RTCS: 44%, p=0.843). There were no significant differences in nonunion (7.4% vs 4.0% p=1.0), superficial infection (3.6% vs 4% p=1.0) or iatrogenic nerve palsy (3.6% vs 4.0% p=1.0) between the MIR-IT and RTCS groups. There were no deep infections or wound dehiscences in either group. Forty-two patients had PROMs (MIR-IT -21; RTCS -21). Average time to PROMs collection was 35.7 months (MIR-IT: 34.2 months, RTCS: 37.1 months, p=0.682). There were significantly better ASES scores (82.7 vs 71.6 p=.015), Quick DASH scores (9.7 vs 21.0 p=.011) and Oxford Shoulder Scores (39.3 vs 33.9 p=.042) amongst patients treated with the MIR-IT.</p><p><strong>Conclusions: </strong>Humeral IMN utilizing the MIR-IT resulted in better shoulder PROMs compared to the RTCS technique, with similarly low surgical complication rates.</p><p><strong>Level of evidence: </strong>Therapeutic Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000002993","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To assess whether patients treated with a Minimally Invasive Rotator-Interval Technique (MIR-IT) versus the traditional technique of splitting the rotator cuff (RTCS) for intramedullary nailing of humeral shaft fractures resulted in comparable post-operative clinical and patient-reported outcomes (PROM).
Methods: Design: Retrospective Cohort Study.
Setting: Level 1 Trauma Center.
Patient selection criteria: Patients >18yo with humeral shaft fractures (AO/OTA 12A-C) treated with IMN between 2015 and 2022.
Outcome measures and comparisons: The primary outcome was differences in PROMs (ASES, Quick DASH, and Oxford Shoulder Score) between the MIR-IT and RTCS techniques. Secondary outcome measures included differences in rates of nonunion, superficial and deep surgical infections, wound dehiscence and iatrogenic nerve palsy between the two techniques.
Results: Seventy-one patients underwent humeral IMN (MIR-IT - 39; RTCS - 32). Fifty-five patients (MIR-IT- 30; RTCS-25) had radiographic and clinical follow up to union. Mean follow up was 7.5 months (range: 3.1-16.8 months). Patients did not vary significantly with regards to age (MIR-IT: 54.4 ± 22.4; RTCS: 55.1 ± 18.5 years, p=0.896), and gender (Males- MIR-IT: 46.7%, RTCS: 44%, p=0.843). There were no significant differences in nonunion (7.4% vs 4.0% p=1.0), superficial infection (3.6% vs 4% p=1.0) or iatrogenic nerve palsy (3.6% vs 4.0% p=1.0) between the MIR-IT and RTCS groups. There were no deep infections or wound dehiscences in either group. Forty-two patients had PROMs (MIR-IT -21; RTCS -21). Average time to PROMs collection was 35.7 months (MIR-IT: 34.2 months, RTCS: 37.1 months, p=0.682). There were significantly better ASES scores (82.7 vs 71.6 p=.015), Quick DASH scores (9.7 vs 21.0 p=.011) and Oxford Shoulder Scores (39.3 vs 33.9 p=.042) amongst patients treated with the MIR-IT.
Conclusions: Humeral IMN utilizing the MIR-IT resulted in better shoulder PROMs compared to the RTCS technique, with similarly low surgical complication rates.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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