{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T06:38:13Z","timestamp":1769755093435,"version":"3.49.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T00:00:00Z","timestamp":1632096000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T00:00:00Z","timestamp":1632096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We hypothesized that postoperative malrotation of humeral shaft fractures can alter the bio-mechanical environment of the shoulder; thus, rotator cuff and cartilage degeneration could be induced. Therefore, we designed an animal experiment to evaluate the impact of malrotation deformities after minimally invasive surgery for humeral fractures on the rotator cuff and cartilage, which has rarely been described in previous studies. Twenty-four New Zealand white rabbits were randomly divided into the sham control group (A), negative control group (B) and malrotated group (C). A sham operation with surgical exposure alone was performed in group A. Humeral shaft osteotomy was performed in Group B and C. In Group B, the fractures were fixed in situ with plate -screw system. While in Group C, iatrogenic rotational deformity was created after the proximal end of the fracture being internally rotated by 20 degrees and then subsequently fixed. The animals with bone healing were sacrificed for pathological and biochemical examination. In group C, the modified Mankin scale for cartilage pathology evaluation and the modified Movin scale for tendon both showed highest score among groups with statistical significance (P\u2009&lt;\u20090.05); Disordered alignment and proportion of collagen I\/III of rotator cuff were confirmed with picrosirius red staining; Transmission electron microscopy also showed ultrastructural tendon damage. Immunohistochemistry showed that both MMP-1 and MMP-13 expression were significantly higher in group C than groups A and B(P\u2009&lt;\u20090.05). Minimally invasive techniques for humerus shaft fracture might be cosmetically advantageous, but the consequent postoperative malrotation could increase the risk of rotator cuff and cartilage degeneration. This conclusion is supported here by primary evidence from animal experiments.\n<\/jats:p>","DOI":"10.1038\/s41598-021-98040-6","type":"journal-article","created":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T10:02:53Z","timestamp":1632132173000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Postoperative malrotation of humerus shaft fracture causes degeneration of rotator cuff and cartilage"],"prefix":"10.1038","volume":"11","author":[{"given":"Cheng","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyuan","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiaohui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guofeng","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,9,20]]},"reference":[{"issue":"4","key":"98040_CR1","doi-asserted-by":"publisher","first-page":"e87","DOI":"10.1016\/j.jse.2017.10.028","volume":"27","author":"GF Updegrove","year":"2018","unstructured":"Updegrove, G. F., Mourad, W. & Abboud, J. A. Humeral shaft fractures. J. Shoulder Elbow Surg. 27(4), e87\u2013e97 (2018).","journal-title":"J. Shoulder Elbow Surg."},{"issue":"10","key":"98040_CR2","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1007\/s00402-015-2296-5","volume":"135","author":"WJ Metsemakers","year":"2015","unstructured":"Metsemakers, W. J., Wijnen, V., Sermon, A., Vanderschot, P. & Nijs, S. Intramedullary nailing of humeral shaft fractures: failure analysis of a single centre series. Arch. Orthop. Trauma Surg. 135(10), 1391\u20131399 (2015).","journal-title":"Arch. Orthop. Trauma Surg."},{"issue":"2","key":"98040_CR3","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.jse.2017.08.004","volume":"27","author":"NJ Zarkadis","year":"2018","unstructured":"Zarkadis, N. J. et al. Open reduction-internal fixation versus intramedullary nailing for humeral shaft fractures: an expected value decision analysis. J. Shoulder Elbow Surg. 27(2), 204\u2013210 (2018).","journal-title":"J. Shoulder Elbow Surg."},{"issue":"18","key":"98040_CR4","doi-asserted-by":"publisher","first-page":"652","DOI":"10.5435\/JAAOS-D-17-00238","volume":"26","author":"K Tetsworth","year":"2018","unstructured":"Tetsworth, K., Hohmann, E. & Glatt, V. Minimally invasive plate osteosynthesis of humeral shaft fractures: Current state of the art. J. Am. Acad. Orthop. Surg. 26(18), 652\u2013661 (2018).","journal-title":"J. Am. Acad. Orthop. Surg."},{"issue":"7","key":"98040_CR5","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1097\/BOT.0000000000001457","volume":"33","author":"GG Costa","year":"2019","unstructured":"Costa, G. G. et al. External fixation as a definitive treatment for humeral shaft fractures: Radiographic and functional results with analysis of outcome predictors. J. Orthop. Trauma 33(7), 354\u2013360 (2019).","journal-title":"J. Orthop. Trauma"},{"issue":"7","key":"98040_CR6","doi-asserted-by":"publisher","first-page":"583","DOI":"10.2106\/JBJS.16.00628","volume":"99","author":"FT Matsunaga","year":"2017","unstructured":"Matsunaga, F. T. et al. Minimally invasive osteosynthesis with a bridge plate versus a functional brace for humeral shaft fractures: A randomized controlled trial. J. Bone. Jt. Surg. Am. 99(7), 583\u2013592 (2017).","journal-title":"J. Bone. Jt. Surg. Am."},{"issue":"11","key":"98040_CR7","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1016\/j.jse.2015.07.032","volume":"24","author":"C Wang","year":"2015","unstructured":"Wang, C., Li, J., Li, Y., Dai, G. & Wang, M. Is minimally invasive plating osteosynthesis for humeral shaft fracture advantageous compared with the conventional open technique. J. Shoulder Elbow Surg. 24(11), 1741\u20131748 (2015).","journal-title":"J. Shoulder Elbow Surg."},{"issue":"6","key":"98040_CR8","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1016\/j.jse.2010.12.016","volume":"20","author":"Y Li","year":"2011","unstructured":"Li, Y., Wang, C., Wang, M., Huang, L. & Huang, Q. Postoperative malrotation of humeral shaft fracture after plating compared with intramedullary nailing. J. Shoulder Elbow Surg. 20(6), 947\u2013954 (2011).","journal-title":"J. Shoulder Elbow Surg."},{"issue":"6","key":"98040_CR9","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.jse.2007.02.130","volume":"16","author":"MP Flury","year":"2007","unstructured":"Flury, M. P., Goldhahn, J., Holzmann, P. & Simmen, B. R. Does Weber\u2019s rotation osteotomy induce degenerative joint disease at the shoulder in the long term. J. Shoulder Elbow. Surg. 16(6), 735\u2013741 (2007).","journal-title":"J. Shoulder Elbow. Surg."},{"issue":"3","key":"98040_CR10","doi-asserted-by":"publisher","first-page":"309","DOI":"10.32098\/mltj.03.2014.08","volume":"4","author":"F Oliva","year":"2014","unstructured":"Oliva, F., Osti, L., Padulo, J. & Maffulli, N. Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease. Muscles Ligaments Tendons 4(3), 309\u2013314 (2014).","journal-title":"Muscles Ligaments Tendons"},{"issue":"12","key":"98040_CR11","doi-asserted-by":"publisher","first-page":"2457","DOI":"10.1016\/j.jse.2019.05.008","volume":"28","author":"MB Zaid","year":"2019","unstructured":"Zaid, M. B. et al. Anatomic shoulder parameters and their relationship to the presence of degenerative rotator cuff tears and glenohumeral osteoarthritis: a systematic review and meta-analysis. J Shoulder Elbow Surg. 28(12), 2457\u20132466 (2019).","journal-title":"J Shoulder Elbow Surg."},{"issue":"3","key":"98040_CR12","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1177\/0363546507308549","volume":"36","author":"UG Longo","year":"2008","unstructured":"Longo, U. G. et al. Histopathology of the supraspinatus tendon in rotator cuff tears. Am. J. Sports Med. 36(3), 533\u2013538 (2008).","journal-title":"Am. J. Sports Med."},{"issue":"10","key":"98040_CR13","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1369\/0022155414545787","volume":"62","author":"R Lattouf","year":"2014","unstructured":"Lattouf, R. et al. Picrosirius red staining: a useful tool to appraise collagen networks in normal and pathological tissues. J. Histochem. Cytochem. 62(10), 751\u2013758 (2014).","journal-title":"J. Histochem. Cytochem."},{"issue":"3","key":"98040_CR14","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1111\/os.12627","volume":"13","author":"J Liu","year":"2021","unstructured":"Liu, J. et al. Picrosirius-polarization method for collagen fiber detection in tendons: A mini-review. Orthop. Surg. 13(3), 701\u2013707 (2021).","journal-title":"Orthop. Surg."},{"issue":"5","key":"98040_CR15","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1177\/0300985815588611","volume":"52","author":"AM McCoy","year":"2015","unstructured":"McCoy, A. M. Animal models of osteoarthritis: Comparisons and key considerations. Vet. Pathol. 52(5), 803\u2013818 (2015).","journal-title":"Vet. Pathol."},{"issue":"1","key":"98040_CR16","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1002\/jor.1100100107","volume":"10","author":"JA van der Sluijs","year":"1992","unstructured":"van der Sluijs, J. A. et al. The reliability of the Mankin score for osteoarthritis. J. Orthop. Res. 10(1), 58\u201361 (1992).","journal-title":"J. Orthop. Res."},{"issue":"1","key":"98040_CR17","doi-asserted-by":"publisher","first-page":"43","DOI":"10.2174\/1574888X09666140710110723","volume":"10","author":"M Loppini","year":"2015","unstructured":"Loppini, M. et al. Histopathological scores for tissue-engineered, repaired and degenerated tendon: a systematic review of the literature. Curr. Stem Cell Res. Ther. 10(1), 43\u201355 (2015).","journal-title":"Curr. Stem Cell Res. Ther."},{"key":"98040_CR18","first-page":"1","volume":"1","author":"A Hasegawa","year":"2021","unstructured":"Hasegawa, A., Mihata, T., Itami, Y., Fukunishi, K. & Neo, M. Histologic changes during healing with autologous fascia lata graft after superior capsule reconstruction in rabbit model. J. Shoulder Elbow Surg. 1, 1 (2021).","journal-title":"J. Shoulder Elbow Surg."},{"issue":"6","key":"98040_CR19","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1152\/japplphysiol.00609.2020","volume":"129","author":"SA Hyman","year":"2020","unstructured":"Hyman, S. A. et al. In vivo supraspinatus muscle contractility and architecture in rabbit. J. Appl. Physiol. (1985) 129(6), 1405\u20131412 (2020).","journal-title":"J. Appl. Physiol. (1985)"},{"issue":"6","key":"98040_CR20","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.1177\/0363546520908847","volume":"48","author":"C Wang","year":"2020","unstructured":"Wang, C., Hu, Q., Song, W., Yu, W. & He, Y. Adipose stem cell-derived exosomes decrease fatty infiltration and enhance rotator cuff healing in a rabbit model of chronic tears. Am. J. Sports Med. 48(6), 1456\u20131464 (2020).","journal-title":"Am. J. Sports Med."},{"issue":"1","key":"98040_CR21","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1080\/17453670902807425","volume":"80","author":"RC Grumet","year":"2009","unstructured":"Grumet, R. C., Hadley, S., Diltz, M. V. & Lee, T. Q. Development of a new model for rotator cuff pathology: the rabbit subscapularis muscle. Acta Orthop. 80(1), 97\u2013103 (2009).","journal-title":"Acta Orthop."},{"issue":"4","key":"98040_CR22","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/S1058-2746(98)90026-X","volume":"7","author":"AG Schneeberger","year":"1998","unstructured":"Schneeberger, A. G., Nyffeler, R. W. & Gerber, C. Structural changes of the rotator cuff caused by experimental subacromial impingement in the rat. J. Shoulder Elbow Surg. 7(4), 375\u2013380 (1998).","journal-title":"J. Shoulder Elbow Surg."},{"issue":"8","key":"98040_CR23","doi-asserted-by":"publisher","first-page":"2440","DOI":"10.1007\/s11999-013-3439-z","volume":"472","author":"K Otarodifard","year":"2014","unstructured":"Otarodifard, K. et al. Relative fixation strength of rabbit subscapularis repair is comparable to human supraspinatus repair at time 0. Clin. Orthop. Relat. Res. 472(8), 2440\u20132447 (2014).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"11","key":"98040_CR24","doi-asserted-by":"publisher","first-page":"1897","DOI":"10.1016\/j.jse.2017.04.010","volume":"26","author":"JO Kim","year":"2017","unstructured":"Kim, J. O. et al. Rotator cuff bridging repair using acellular dermal matrix in large to massive rotator cuff tears: histologic and clinical analysis. J. Shoulder Elbow Surg. 26(11), 1897\u20131907 (2017).","journal-title":"J. Shoulder Elbow Surg."},{"issue":"11","key":"98040_CR25","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.2217\/rme-2018-0125","volume":"14","author":"DR Kwon","year":"2019","unstructured":"Kwon, D. R., Park, G. Y. & Lee, S. C. Regenerative effects of mesenchymal stem cells by dosage in a chronic rotator cuff tendon tear in a rabbit model. Regen Med. 14(11), 1001\u20131012 (2019).","journal-title":"Regen Med."},{"issue":"7","key":"98040_CR26","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1177\/0363546518764685","volume":"46","author":"X Li","year":"2018","unstructured":"Li, X., Shen, P., Su, W., Zhao, S. & Zhao, J. Into-tunnel repair versus onto-surface repair for rotator cuff tears in a rabbit model. Am. J. Sports Med. 46(7), 1711\u20131719 (2018).","journal-title":"Am. J. Sports Med."},{"issue":"3","key":"98040_CR27","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1177\/0363546519896350","volume":"48","author":"Y Sun","year":"2020","unstructured":"Sun, Y. et al. Small subchondral drill holes improve marrow stimulation of rotator cuff repair in a rabbit model of chronic rotator cuff tear. Am. J. Sports. Med. 48(3), 706\u2013714 (2020).","journal-title":"Am. J. Sports. Med."},{"key":"98040_CR28","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-020-04754-z","author":"EG Haritinian","year":"2020","unstructured":"Haritinian, E. G., Belgaid, V., Lino, T. & Nov\u00e9-Josserand, L. Reverse versus anatomical shoulder arthroplasty in patients with intact rotator cuff. Int. Orthop. https:\/\/doi.org\/10.1007\/s00264-020-04754-z (2020)."},{"issue":"3","key":"98040_CR29","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00264-018-4088-3","volume":"43","author":"G Merolla","year":"2019","unstructured":"Merolla, G. et al. Assessment of anatomical and reverse total shoulder arthroplasty with the scapula-weighted Constant-Murley score. Int. Orthop. 43(3), 659\u2013667 (2019).","journal-title":"Int. Orthop."},{"issue":"7","key":"98040_CR30","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1302\/0301-620X.95B7.31028","volume":"5-B","author":"BK Moor","year":"2013","unstructured":"Moor, B. K. et al. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle. Bone Jt. J. 5-B(7), 935 (2013).","journal-title":"Bone Jt. J."},{"issue":"1","key":"98040_CR31","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.jse.2018.05.041","volume":"28","author":"DC Meyer","year":"2019","unstructured":"Meyer, D. C. et al. Small anteroposterior inclination of the acromion is a predictor for posterior glenohumeral erosion (B2 or C). J. Shoulder Elbow Surg. 28(1), 22\u201327 (2019).","journal-title":"J. Shoulder Elbow Surg."},{"issue":"1","key":"98040_CR32","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1177\/2309499017690317","volume":"25","author":"MF Miswan","year":"2017","unstructured":"Miswan, M. F. et al. Correlation between anatomy of the scapula and the incidence of rotator cuff tear and glenohumeral osteoarthritis via radiological study. J. Orthop. Surg. (Hong Kong) 25(1), 2017 (2017).","journal-title":"J. Orthop. Surg. (Hong Kong)"},{"issue":"4","key":"98040_CR33","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1016\/j.jse.2013.11.008","volume":"23","author":"BK Moor","year":"2017","unstructured":"Moor, B. K. et al. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J. Shoulder Elbow Surg. 23(4), 536\u2013541 (2017).","journal-title":"J. Shoulder Elbow Surg."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-98040-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-98040-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-98040-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T15:43:20Z","timestamp":1670082200000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-98040-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,20]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["98040"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-98040-6","relation":{"references":[{"id-type":"uri","id":"","asserted-by":"subject"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,20]]},"assertion":[{"value":"10 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"18596"}}