Treatment of humeral shaft fractures using antegrade nailing: functional outcome in the shoulder Juan Martin Patino, MD* Departamento de Ortopedia y Traumatologia, Servicio de cirugıa de miembro superior, Hospital Militar Central ‘‘Cosme Argerich’’, Buenos Aires, Argentina Background: The purpose of this study was to evaluate shoulder outcomes and function after humeral shaft fractures treated with antegrade nailing. Materials and methods: Thirty patients with acute humeral shaft fractures who underwent antegrade locked intramedullary nailing were retrospectively studied. Range of motion (ROM) of the affected shoul- der was evaluated, comparing it with the nonaffected shoulder, radiologic position of the nails, complica- tions, and need for a second surgery. Results: The study enrolled 20 men and 10 women (average age, 41.9 years). The average follow-up was 35.8 months. The average shoulder elevation averaged 157  , internal rotation was variable (reaching the sacroiliac joint to T7), and external rotation averaged 75  . Elbow flexion-extension ROM averaged 133  (115  -145  ). According to the Rodriguez-Merchan criteria, 12 patients achieved excellent results (40%), 7 good (20%), and 6 fair (23.3%); poor results were found in 5 cases (16.6%). Twelve patients achieved full mobility of the shoulder, whereas 18 had some loss of motion, with significant differences between the affected and nonaffected shoulders (P ¼ .001). Conclusion: Decreased shoulder ROM is common after antegrade nailing of humeral shaft fractures. Avoidance of nail impingement can improve final outcomes. Level of evidence: Level IV, Case Series, Treatment Study. Ó 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Keywords: Shoulder; shoulder function; humeral shaft fractures; fracture fixation; antegrade nailing Treatment of humeral shaft fractures continues to be controversial. Nonoperative functional treatment has been considered the ‘‘gold standard’’ by numerous authors. This approach is based on publications such as that by Sarmiento et al. 24 Various absolute and relative surgical indications have been published although not always well described. Examples of relative indications for surgery are intolerance to immobilization and inability to maintain an adequate reduction of the fracture. The most accepted surgical techniques to treat humeral shaft fractures include internal fixation with plates and screws, antegrade or retrograde locked intramedullary (IM) nailing, and placement of an external fixator. 15,16,25 The main controversy discussed by different authors has been between open reduction and internal fixation (ORIF) and locked IM nailing. 4,7,19 Institutional Review Board approval was obtained by, Comite de etica, Hospital Militar Central, No: HGRL 601-HMC. *Reprint requests: Juan Martin Patino, MD, Av. Juan de Garay 2235 1er piso B., 1256, Buenos Aires, Argentina. E-mail address: drpatinojm@gmail.com J Shoulder Elbow Surg (2015) -, 1-5 www.elsevier.com/locate/ymse 1058-2746/$ - see front matter Ó 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. http://dx.doi.org/10.1016/j.jse.2015.01.009