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The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study
BACKGROUND: Proximal humeral fracture is the third most common of osteoporotic fracture. Most surgical cases were treated by fixation with anatomical locking plate system. The calcar screw plays a role in medial support and improving varus stability. Proximal humerus fracture in elderly patients are...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725298/ https://www.ncbi.nlm.nih.gov/pubmed/34983577 http://dx.doi.org/10.1186/s13018-021-02892-7 |
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author | Kulkamthorn, Nattha Rungrattanawilai, Naruebade Tarunotai, Thanakorn Chuvetsereporn, Nantaphon Chansela, Piyachat Phruetthiphat, Ong-art |
author_facet | Kulkamthorn, Nattha Rungrattanawilai, Naruebade Tarunotai, Thanakorn Chuvetsereporn, Nantaphon Chansela, Piyachat Phruetthiphat, Ong-art |
author_sort | Kulkamthorn, Nattha |
collection | PubMed |
description | BACKGROUND: Proximal humeral fracture is the third most common of osteoporotic fracture. Most surgical cases were treated by fixation with anatomical locking plate system. The calcar screw plays a role in medial support and improving varus stability. Proximal humerus fracture in elderly patients are commonly seen with greater tuberosity (GT) fracture. The GT fragment is sometimes difficult to use as an anatomic landmark for proper plate and screw position. Therefore, the insertion of pectoralis major tendon (PMT) may be used as an alternative landmark for appropriate plate and calcar screw position. The purpose of study is going to identify the vertical distance from PMT to a definite point on the position of locking plate. METHODS: 30 cadaveric shoulders at the department of clinical anatomy were performed. Shoulders with osteoarthritic change (n = 5) were excluded. Finally, 25 soft cadaveric shoulders were recruited in this study. The PHILOS™ plate was placed 2 mm posterior to the bicipital groove. A humeral head (HH) was cut in the coronal plane at the level of the anterior border of the PHILOS plate with a saw. A calcar screw was inserted close to the inferior cortex of HH. Distance from the upper border of elongated combi-hole (UB-ECH) to the upper border of pectoralis major tendon (UB-PMT) was measured. The plate was then moved superiorly until the calcar screw was 12 mm superior to the inferior border of HH and the distance was repeatedly measured. RESULTS: The range of distance from UB-PMT to the UB-ECH was from − 4.50 ± 7.95 mm to 6.62 ± 7.53 mm, when calcar screw was close to inferior border of HH and when the calcar screw was 12 mm superior to the inferior border of HH, respectively. The highest probability of calcar screw in proper location was 72% when UB-ECH was 3 mm above UB-PMT. DISCUSSION AND CONCLUSION: The GT fragment is sometimes difficult to use as an anatomic landmark for proper plate and screw position. PMT can be used as an alternative anatomic reference. UB-PMT can serve as a guide for proper calcar screw insertion. UB-ECH should be 3 mm above UB-PMT and three-fourths of cases achieved proper calcar screw location. |
format | Online Article Text |
id | pubmed-8725298 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-87252982022-01-06 The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study Kulkamthorn, Nattha Rungrattanawilai, Naruebade Tarunotai, Thanakorn Chuvetsereporn, Nantaphon Chansela, Piyachat Phruetthiphat, Ong-art J Orthop Surg Res Research Article BACKGROUND: Proximal humeral fracture is the third most common of osteoporotic fracture. Most surgical cases were treated by fixation with anatomical locking plate system. The calcar screw plays a role in medial support and improving varus stability. Proximal humerus fracture in elderly patients are commonly seen with greater tuberosity (GT) fracture. The GT fragment is sometimes difficult to use as an anatomic landmark for proper plate and screw position. Therefore, the insertion of pectoralis major tendon (PMT) may be used as an alternative landmark for appropriate plate and calcar screw position. The purpose of study is going to identify the vertical distance from PMT to a definite point on the position of locking plate. METHODS: 30 cadaveric shoulders at the department of clinical anatomy were performed. Shoulders with osteoarthritic change (n = 5) were excluded. Finally, 25 soft cadaveric shoulders were recruited in this study. The PHILOS™ plate was placed 2 mm posterior to the bicipital groove. A humeral head (HH) was cut in the coronal plane at the level of the anterior border of the PHILOS plate with a saw. A calcar screw was inserted close to the inferior cortex of HH. Distance from the upper border of elongated combi-hole (UB-ECH) to the upper border of pectoralis major tendon (UB-PMT) was measured. The plate was then moved superiorly until the calcar screw was 12 mm superior to the inferior border of HH and the distance was repeatedly measured. RESULTS: The range of distance from UB-PMT to the UB-ECH was from − 4.50 ± 7.95 mm to 6.62 ± 7.53 mm, when calcar screw was close to inferior border of HH and when the calcar screw was 12 mm superior to the inferior border of HH, respectively. The highest probability of calcar screw in proper location was 72% when UB-ECH was 3 mm above UB-PMT. DISCUSSION AND CONCLUSION: The GT fragment is sometimes difficult to use as an anatomic landmark for proper plate and screw position. PMT can be used as an alternative anatomic reference. UB-PMT can serve as a guide for proper calcar screw insertion. UB-ECH should be 3 mm above UB-PMT and three-fourths of cases achieved proper calcar screw location. BioMed Central 2022-01-04 /pmc/articles/PMC8725298/ /pubmed/34983577 http://dx.doi.org/10.1186/s13018-021-02892-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Kulkamthorn, Nattha Rungrattanawilai, Naruebade Tarunotai, Thanakorn Chuvetsereporn, Nantaphon Chansela, Piyachat Phruetthiphat, Ong-art The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study |
title | The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study |
title_full | The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study |
title_fullStr | The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study |
title_full_unstemmed | The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study |
title_short | The proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study |
title_sort | proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location: a cadaveric study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725298/ https://www.ncbi.nlm.nih.gov/pubmed/34983577 http://dx.doi.org/10.1186/s13018-021-02892-7 |
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