![]() The pectorals major insertion has a reproducible relation to the bicipital groove, making it a good landmark for tuberosities positioning in case of fracture reconstruction. The mean distance to the posterior fin of the prosthesis was 10 mm and the mean angle 25 degrees. The pectoralis major insertion is also very reproducible regarding its relationship to retroversion. In a study using the pectoralis major tendon as a reference intraoperatively reconstruction of the height of the humerus prosthesis measured by evaluating the radiological humeral length in comparison to the contralateral side within 7 mm +/- 7 mm could be shown. The distance between the superior edge of the pectoralis major and the top of the humeral head might be shorter (49 mm) in Asiatic women. Pectoralis major tendons inserted 54 to 56 mm distal to the superior aspect of the humeral head and 47 mm distal to superomedial tip of greater tuberosity. The superior edge of the pectoralis major and the top of the humeral head is a reliable measure that can be used intraoperatively to decide the height of the humerus prosthesis or humeral head in comminuted fractures of the proximal humerus. ĭifferent situations or pathological position of the greater tuberosity cause impingement and loss of strength: A) Type II cephalotubercular valgus impacted fracture and B) displaced fracture of the greater tuberosity resulting in decreased mobility and loss of strength through relaxation of the cuff. Similarly, a greater tuberosity that is too low will also harm the rotator cuff. Surgical fixation is consequently recommended for fractures with residual displacement greater than 5 mm, or 3 mm in active patients involved in frequent overhead activity. Malunion can result in a mechanical block to shoulder abduction or external rotation and altered rotator cuff mechanics, causing weakness. As little as 5 mm of displacement not only creates impingement, but also insufficiency in the posterosuperior rotator cuff due to lack of tension relative to the Blix curve (Figure). ![]() In non-pathologic conditions, the greater tuberosity is never above the top of the humeral head. Normally, the tuberosity lies 8☑.2 mm (range, 6 to 10 mm) below the superior most portion of the humeral head. The height of the greater tuberosity in relation to the head is crucial. Anatomy MorphologyĪnatomical restitution, and especially the position of the tuberosities after fixation and during all reconstruction work, is essential. Their incidence, having drastically increased between 1970 (87/100'000 individuals) and 1995 (304/100'000 individuals) seems, for no clear reason, to have reached a plateau since 2010 (297/100'000 individuals in 2015). They represent 5% of all fractures in patients over 40 years of age. Proximal humeral fractures are limited to those located above the insertion point of the superior edge of the pectoralis major. Shoulder Proximal humerus fracture Arthroscopy Osteosynthesis Hemi arthroplasty Intramedullary nailing Plate Reverse implant. If this is not the case, then rehabilitation should be deferred and the patient immobilized in the meantime. Where stability permits, early, passive mobility rehabilitation should be commenced.The reverse implant is increasingly the treatment of choice for the elderly.According to the literature there is no difference between antegrade intramedullary nailing and plate osteosynthesis.The surgical treatment is difficult and should, in cases of osteosynthesis, lead to an anatomical result.The decisive elements of choice between osteosynthesis and implant are essentially the patient’s age, the risk of humeral head necrosis and bone strength.Assessment of an acute proximal humerus fracture includes a complete trauma series radiography and, where surgical treatment is considered, a CT scan with three-dimensional reconstruction.1.12.5 Isolated sub-tubercular fractures.1.12.4 Type II-IV cephalotubercular in the elderly.1.12.3 Type II-IV cephalotubercular in the young.1.12.2 Displaced tuberosity fractures with a stable epiphyseal-diaphyseal union.1.11.3 Non-stable osteosynthesis and implants.1.11.2 Osteosynthesis with Relative Stability. ![]() 1.8.5.2 Complications of plate osteosynthesis.1.8.5.1 Surgical Technique (Operative Treatment).1.8.3 Percutaneous Antegrade Intramedullary Nailing.1.8.2 Percutaneous Pinning or Screw Fixation.1.6 Conservative Treatment (Nonoperative Treatment).1.5 Types of Fracture and Classification. ![]()
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