Correlation between the retroversion of the humeral head and the orientation of the intertubercular sulcus: a CT scan anatomical study

Background: Percutaneous insertion of third-generation straight humeral nails is a recent alternative to the conventional open method. Rather than splitting, retracting and subsequently repairing the supraspinatus fibers to visualize the humeral head entry site, the percutaneous approach utilizes a cannulated awl to enter the intramedullary canal through the supraspinatus fibers without visualizing internal shoulder structures. Despite recent evidence demonstrating satisfactory outcomes in the percutaneous method, the potential for iatrogenic injury to the rotator cuff and other shoulder structures is not fully understood. Materials and Methods: We performed an anatomical study of 46 shoulders in 23 cadavers to compare damage caused to internal shoulder structures between the open and percutaneous techniques. Dimensions and morphologies of supraspinatus and humeral head perforations were recorded. Results: The percutaneous technique produced greater latitudinal tearing ( p = 0.002) and less longitudinal tearing ( p < 0.001) of muscle fibers, however there was no difference in supraspinatus hole area ( p = 0.748). The long head biceps tendon was within 3 mm of the bone entry hole in 13 (28%) shoulders, with one shoulder in the open group exhibiting full tendon transection. Conclusions: Percutaneous insertion of intramedullary nails using a cannulated awl appears to produce similar soft tissue and bone entry site morphology as compared to the conventional open technique. The percutaneous method was associated with slightly greater latitudinal tearing, however the effects of this remain to be clarified through clinical studies. External rotation should be avoided during instrumentation to reduce the risk of biceps tendon transection.

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CT Scan Method Accurately Assesses Humeral Head Retroversion

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-007-0089-z ◽

2008 ◽

Vol 466 (3) ◽

pp. 661-669 ◽

Cited By ~ 53

Author(s):

P. Boileau ◽

R. T. Bicknell ◽

N. Mazzoleni ◽

G. Walch ◽

J. P. Urien

Keyword(s):

Ct Scan ◽

Humeral Head

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The arterial vascularization of the humeral head. An anatomical study.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-199072100-00009 ◽

1990 ◽

Vol 72 (10) ◽

pp. 1486-1494 ◽

Cited By ~ 301

Author(s):

C Gerber ◽

A G Schneeberger ◽

T S Vinh

Keyword(s):

Humeral Head ◽

Anatomical Study ◽

Arterial Vascularization

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CT-scan imaging of iron marked chorda tympani nerve: anatomical study and educational perspectives

Surgical and Radiologic Anatomy ◽

10.1007/s00276-011-0799-5 ◽

2011 ◽

Vol 33 (6) ◽

pp. 515-521 ◽

Cited By ~ 4

Author(s):

Olivier Trost ◽

René-Charles Rouchy ◽

Charles Teyssier ◽

Apolline Kazemi ◽

Narcisse Zwetyenga ◽

...

Keyword(s):

Ct Scan ◽

Anatomical Study ◽

Chorda Tympani ◽

Chorda Tympani Nerve

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Anterior Skull Base Analysis from Coronal and Reconstructed Computed Tomography: Radio-Anatomical Study

Nepal Medical College Journal ◽

10.3126/nmcj.v23i4.42216 ◽

2021 ◽

Vol 23 (4) ◽

pp. 302-307

Author(s):

Bhima Neupane ◽

Phanindra Prasad Poudel ◽

Prakash Sharma ◽

Krishna Koirala ◽

Brihaspati Sigdel

Keyword(s):

Ct Scan ◽

Skull Base ◽

Computerized Tomography ◽

Skull Base Surgery ◽

Anatomical Study ◽

Anterior Skull Base ◽

Cribriform Plate ◽

Bony Landmarks ◽

Nasal Floor ◽

Base Analysis

Endoscopic sinus and skull base Surgery has gained significant improvement widely all over the world. A computerized tomography (CT) scan provides a detailed anatomy of the skull base especially the bone framework. This study aims to analyze the fixed anatomical bony landmarks of the anterior skull base through coronal and reconstructed CT in the context of the Nepalese population and guide the surgeon to perform endoscopic sinus and skull base surgery safely. This Prospective study includes 70 Computerized Tomography scans of Paranasal sinuses. The different measurement from nasal floor to skull base was taken in coronal and reformatted sagittal CT scan. Mean, standard deviation, minimum and maximum values were analyzed using descriptive statistics. Student T-test was applied to compare between right and left side. This study includes 75 patients between 18 to 77 years. The measurement from nasal floor to the cribriform plate and ethmoidal roof in right and left side were, mean± SD (47± 4.1, 45.3±4.3, 47.9±5.1, and 49±8.5 mm) respectively. Mean Take off angle at the cribriform plate was 43.9 ±10.9°on right side and 43 ± 9.4° on the left side. The distance from the nasal spine to the skull base (mean ± SD) at nasofrontal recess, bulla ethmoidalis, and the junction of sphenoethmoid levels at right sides were 51.5 ± 4.7, 52.9 ± 4.1, and 61.2 ±4.7 little higher at left side. This study provides a detailed analysis of the anterior skull base in coronal and sagittal CT scans which helps to reduces complications.

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Anatomical Study for the Treatment of Proximal Humeral Fracture Through the Medial Approach

10.21203/rs.3.rs-955263/v1 ◽

2021 ◽

Author(s):

Hao Xiang ◽

Yan Wang ◽

Yongliang Yang ◽

Fanxiao Liu ◽

Qinsen Lu ◽

...

Keyword(s):

Brachial Artery ◽

Humeral Head ◽

Proximal Humeral Fracture ◽

Anatomical Study ◽

Humeral Fracture ◽

Vascular Supply ◽

Coracoid Process ◽

Circumflex Artery ◽

Medial Approach ◽

Process Risk

Abstract Background: The treatment of complex 3- and 4- part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy.Method: Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation.Results: Medial plate can be easily placed in 86.84% anatomical patterns. An interval of 2 to 3cm (24.29 ± 3.42 mm) was available for internal fixation. ACHA (49.35 ± 8.13 mm, 35.14 - 68.53 mm) and PCHA (49.62 ± 7.82 mm, 37.67 - 66.76 mm) were about 5cm away from the coracoid process. Risk factors including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels; musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA < 1.5. In 13.15% anatomical patterns, this risk factor should be taken seriously. Conclusion: The medial approach opens a new perspective in the optimal management of complex fractures of proximal humerus. Anatomical research proves that the medial approach is feasible. The interval between ACHA and PCHA is suitable for placement. Anatomical pattern and indication have been discussed, and we hypothesized that ACHA has been destroyed in complex PHFs. With further studies on the anatomy and mechanism of injury, the development of more clinical cases will be an important work of our institution in the future.

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