Intramedullary fixation of proximal humerus fractures: do locking bolts endanger the axillary nerve or the ascending branch of the anterior circumflex artery? A cadaveric study

Abstract Background Because of the broad anatomical variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its association with the humeral length to predict the axillary nerve location. This study aimed to analyze the acromion-axillary nerve distance (AAND) and its relation to the arm length (AL) in patients who underwent internal plate fixation for proximal humerus fractures.Methods The present prospective study involved 37 patients (15 female, 22 male; the mean age = 51 years, age range = 19 to 76) with displaced proximal humerus fractures who were treated by open reduction and internal fixation. After anatomic reduction and fixation was achieved, the following parameters were measured in each patient before wound closure without making an extra incision or dissection: (1) the distance from the anterolateral edge of the acromion to the course of axillary nerve was recorded as the acromion-axillary nerve distance and (2) the distance from the anterolateral edge of the acromion to the lateral epicondyle of the humerus was recorded as arm length. The ratio of AAND to AL was then calculated and recorded as the axillary nerve index.Results The mean AAND was 6 ± 0.36 cm (range = 5.5–6.6), and the mean arm length was 32.91 ± 2.9 cm (range = 24–38). The mean axillary nerve ratio was 0.18 ± 0.02 (range = 0.16 to 0.23). There was a significant moderate positive correlation between AL and AAND (p = 0.006; r = 0.447). The axillary nerve location was predictable in only 18% of the patients.Conclusion During the anterolateral deltoid-splitting approach to the shoulder joint, 5.5 cm from the anterolateral edge of the acromion could be considered as a safe zone for the prevention of possible axillary nerve injury.

Download Full-text

Pectoralis Major Tendon as Landmark for Proximal Humerus Surgery: A Cadaveric Study on the Adult Filipino Population

Acta Medica Philippina ◽

10.47895/amp.v55i3.1780 ◽

2021 ◽

Vol 55 (3) ◽

Author(s):

Patrick M. Dizon ◽

Daniel William T. Yu ◽

Donnel Alexis T. Rubio

Keyword(s):

Humeral Head ◽

Proximal Humerus ◽

Constant Factor ◽

Pectoralis Major ◽

Cadaveric Study ◽

Proximal Humerus Fractures ◽

Moderate Correlation ◽

Humerus Fractures ◽

Left And Right ◽

Tendon Insertion

Objective. It is common to get lost during a comminuted proximal humerus surgery, and the pectoralis major insertion is always a constant. Therefore, this study aimed to do a cadaveric study on the Filipino population to assess the distance from the pectoralis major tendon to the top of the humeral head (PMT) as a reference during proximal humerus surgery. Methods. This study dissected the shoulders of cadavers. The distance from the pectoralis major tendon insertion to the top of the humeral head (PMT) was measured using a caliper. This PMT distance was also correlated to the cadaver's height and sex. Results. This study dissected 110 shoulders (55 cadavers | 24 females, 31 males). The median PMT was 5.40 cm for males and 4.90 cm for females, with a combined value of 5.40 cm overall. There was a direct and moderate correlation between the PMT with overall height. Height and PMT of both the left and right shoulder were significantly longer among males compared to females. The study showed that for every centimeter increase in the height of males, there was a corresponding 0.02 cm increase in the PMT, adding the constant factor of 1.83. A corresponding 0.04 cm increase in the PMT for females added the constant factor of -0.81. Conclusion. The pectoralis major tendon insertion is a consistent landmark that can accurately restore humeral length when reconstructing complex proximal humerus fractures where landmarks are otherwise lost because of comminution.

Download Full-text

Midterm Treatment Outcomes of Proximal Humerus Fractures by Intramedullary Fixation

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2018-24-4-81-88 ◽

2018 ◽

Vol 24 (4) ◽

pp. 81-88 ◽

Cited By ~ 1

Author(s):

K. A. Egiazaryan ◽

A P. Ratyev ◽

D. I. Gordienko ◽

A. V. Grigoriev ◽

N. V. Ovcharenko

Keyword(s):

Treatment Outcomes ◽

Intramedullary Nailing ◽

Proximal Humerus ◽

Plate Fixation ◽

Main Group ◽

Intramedullary Fixation ◽

High Rate ◽

Fixation Method ◽

Proximal Humerus Fractures ◽

Humerus Fractures

Background.Treatment tactics of proximal humerus fractures remains a matter of dispute due to multiple cases of unsatisfactory outcomes and high rate of postoperative complications.The aim of the study—to evaluate midterm outcomes of intramedullary fixation for treatment the proximal humerus fractures in comparison with plate fixation.Material and Methods.The authors evaluated treatment outcomes of 175 patients with proximal humerus fractures who underwent surgery in the period from 2012 to 2017. Depending on the fixation method the patients were divided into two groups: the main group consisted of 107 patients who underwent intramedullary fixation by a nail of third generation; a comparison group — consisting of 68 patients who underwent fixation by a locking plate with angular stability.Results.In one year after intramedullary nail fixation the authors observed the excellent and good outcomes on Constant scale in 83.2% of cases, satisfactory — 12.1%, unsatisfactory — 4.7%. Patients who underwent plate fixation demonstrated the following outcomes: excellent and good — 73.5%, satisfactory — 17.7%, unsatisfactory — in 8.8%. Constant score increase was equal in the main and control groups and varied depending on the fracture type.Conclusion.Intramedullary nailing is an option for treatment of all fracture types of proximal humerus as well as for the cases of combined humeral neck and diaphysis fractures. Functional recovery parameters were higher in the main group of patients after intramedullary nailing.

Download Full-text