Cadaveric study of the anatomical reference points for proximal humeral plate positioning
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Complications following locking plate fixation in proximal humeral fractures often related to malposition plates and inadequate screw fixation. However, literature did not define the best anatomical reference point for plate positioning. We conducted a study to assess the occurrence of subacromial impingement and screw perforation with two anatomical reference points for proximal humeral plate positioning.
Sixty shoulders of 30 cadavers were dissected, and proximal humeral locking plate was placed in two different levels in the coronal plane of the upper tip of plate: (1) the proximal portion of bicipital groove group and (2) the most prominent of lesser tuberosity group. Subacromial impingement during passive forward elevation and screw perforation were assessed in relation to the plate positioning.
No subacromial impingement during passive motion contacted to the plate in both groups. The calcar screw perforation rate was significantly lower in the proximal portion of the bicipital groove group (2 of 60 specimens, 3.33%) than the most prominent of lesser tuberosity group (52 of 60 specimens, 86.67%). The most proximal screws of the plate were no humeral head perforation in all specimens.
Our study would suggest that two anatomical reference points could be used to be the landmark to avoid the subacromial impingement and the most proximal screw perforation. However, the placement of the locking plate using the proximal portion of bicipital groove reference is better for calcar screw insertion.
KeywordsProximal humeral fracture Proximal humeral locking plate Cadaveric study Screw perforation
All authors declare no funding source or sponsor involvement in the study design, collection, analysis, and interpretation of the data, in writing the manuscript, and in submission of the manuscript for publication.
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Conflict of interest
The authors declare that they have no conflict of interests regarding the publication of this paper.
- 11.Südkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kääb M, Luo C, Plecko M, Wendt K, Köstler W, Konrad G (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Jt Surg Am 91(6):1320–1328CrossRefGoogle Scholar
- 12.Maddah M, Prall WC, Geyer L, Wirth S, Mutschler W, Ockert B (2014) Is loss of fixation following locked plating of proximal humeral fractures related to the number of screws and their positions in the humeral head? Orthop Rev (Pavia) 6(2):5336. https://doi.org/10.4081/or.2014.5336 CrossRefGoogle Scholar