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Correlation of head screw lengths in proximal humerus nailing: a CT-based study on 289 cases

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Nailing of the proximal humerus is an established method for the treatment of proximal humerus fractures. Choice of the correct length for potentially four proximal locking screws is essential for postoperative outcome. Due to positioning of the patient, intraoperative determination of the correct length of the anteroposterior (AP) screw with the x-ray beam is particularly challenging even for experienced surgeons. We hypothesized that there would be a correlation between the projected lengths of the different proximal locking screws and therefore the length of the AP-screw could be determined based on the three lateromedial (LM) screws.

Materials and methods

In this retrospective study (level of evidence: III) CT-scans of shoulders of 289 patients were 3D reconstructed with the program Horos. Using the manufacturer Stryker's instructions, the four proximal locking screws of the T2 Humeral Nail system were reproduced in the 3D reconstructed shoulders. The length of the AP-screw was correlated with the lengths of the LM-screws by Linear Regression and Multiple Linear Regression.

Results

The results of this study showed that the lengths of proximal locking screws in proximal humeral nailing correlated significantly with each other. Based on the given data, a formula could be established to calculate the length of the AP-screw based on the lengths of the LM-screws with a probability of 76.5%.

Conclusions

This study was able to show that the length of the AP-screw could be determined from the intraoperatively measured lengths of the LM-screws. As our findings base on measurements performed in CT scans, clinical studies are needed to support our data.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at University Medical Center of Cologne.

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Acknowledgements

We thank Julia Halbach (University of Cologne), Eva Hubrich (University of Cologne) and Marc Decker (University of Cologne) for their measurements and contribution to this publication.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

    Michael Sarter, Andreas Harbrecht, Michael Hackl, Lars P. Müller & Kilian Wegmann

  2. Chirurgische Klinik, St. Elisabeth Hospital, Werthmannstraße 1, 50935, Cologne, Germany

    Thomas C. Koslowsky

  3. Department of Diagnostic and Interventional Radiology, University Medical Center of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany

    Philipp Fervers & Grischa Bratke

Authors
  1. Michael Sarter
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Contributions

Conceptualization: MS, TCK, KW; methodology: MS, MH, KW; formal analysis and investigation: MS; writing—original draft preparation: MS; writing—review and editing: MS, TCK, PF, GB, AH, MH, LPM, KW; resources: PF, GB, LPM; ethics application: AH; supervision: KW.

Corresponding author

Correspondence to Michael Sarter.

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Conflict of interest

Lars P. Müller and Kilian Wegmann receive research support and payment as a consultant by Stryker / Tornier Company. Michael Hackl receives research support by Stryker / Tornier Company. For the remaining authors none were declared.

Ethical approval

This study was approved by Ethikkommission Universität zu Köln.

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We the authors hereby confirm, that that our work is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.

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Sarter, M., Koslowsky, T.C., Fervers, P. et al. Correlation of head screw lengths in proximal humerus nailing: a CT-based study on 289 cases. Arch Orthop Trauma Surg 143, 5027–5034 (2023). https://doi.org/10.1007/s00402-023-04875-1

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