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Arch Orthop Trauma Surg. 2013 Aug;133(8):1089-94. doi: 10.1007/s00402-013-1768-8. Epub 2013 May 17.

The function and muscle strength recovery of shoulder after humeral diaphysis fracture following plating and intramedullary nailing.

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Orthopaedics Department, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.



To evaluate the shoulder function and shoulder girdle muscle strength of humeral diaphysis fractures postoperatively following intramedullary nailing (IMN) and open reduction internal fixation (ORIF).


Fifty cases of humeral diaphysis fractures were randomly allocated into two groups. Antegrade IMN and ORIF were, respectively, performed in group I and II. Union status, functional scoring, range of motion, muscle strength of shoulder girdle including external/internal rotation and abduction/adduction strength were recorded at 18 months after surgery. Statistical package for social sciences 13.0 was used for analysis.


Group I had lower functional score than group II (P < 0.05). Both groups had approximately 50 % of muscle strength loss on injured side. In group II, the internal rotation strength loss was significantly greater compared to group I (P < 0.01). The total side to side (internal plus external) range of rotation (ROR) lack and external ROR lack of involved shoulder was significantly greater in group I (P = 0.005 and 0.049). The range of abduction lack was also significantly greater in group I.


Both surgically treated groups had significant loss of muscle strength of shoulder girdle when measured at 18 months postoperatively. There was greater loss of rotation strength in ORIF group than the IMN group. However, IMN had lower functional scores and a decreased range of motion postoperatively. The assumption that rotator cuff damage caused by nailing leads to weaker abduction strength than plating was not supported.

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