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Related Concept Videos

Bones of the Upper Limb: Humerus01:19

Bones of the Upper Limb: Humerus

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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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The ulna and radius are parallel bones of the antebrachium or the forearm. The ulna lies medially and consists of a bony tip called the olecranon process at its proximal end. This hook-like projection articulates with the olecranon fossa of the humerus and forms the "hinged" ulnohumeral part of the elbow joint. This joint facilitates forearm extension and flexion while preventing its hyperextension. Similarly, the coronoid process, another bony projection on the proximal/anterior side...
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The radius is longer of the two bones that make up the human antebrachium or forearm. At the proximal end, the radius articulates with the capitulum of the humerus and the radial notch of the ulna to form the elbow joint. At the distal end, the radius articulates with the ulna via the ulnar notch, forming the distal radioulnar joint. Distally, the radius also attaches to the carpal wrist bones (scaphoid and lunate) to form the radiocarpal joint.
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Adjustable Stiffness, External Fixator for the Rat Femur Osteotomy and Segmental Bone Defect Models
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Novel Technical Factors Affecting Proximal Humerus Fixation Stability.

G-Yves Laflamme1,2, Philippe Moisan2, Julien Chapleau1

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Summary

Proper proximal humerus fracture fixation requires careful attention to reduction quality and medial support. Avoiding long screws and excessive lateral translation minimizes complications like screw cut-out and loss of reduction.

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Area of Science:

  • Orthopedic surgery
  • Biomechanics
  • Radiology

Background:

  • Intra-articular screw cut-out is a frequent complication in proximal humerus fracture (PHF) fixation.
  • Locking plates are commonly used, but mechanical failures persist.

Purpose of the Study:

  • To investigate technical factors influencing mechanical failures and complications in PHF fixation.
  • To identify specific surgical parameters associated with adverse outcomes.

Main Methods:

  • Retrospective radiological analysis of 110 consecutive PHF patients treated with Synthes Philos locking plates.
  • Assessment of reduction quality, humeral head offset, screw characteristics, and medial support.
  • Radiographic evaluation for screw cut-out, loss of reduction, and other complications.

Main Results:

  • Screws longer than 45 mm in proximal rows significantly increased screw cut-out risk (OR=5.3).
  • Lateral translation of the humeral diaphysis over 6 mm correlated with loss of reduction (OR=2.7).
  • Lack of medial support (OR=4.9) and varus reduction (OR=4.3) were associated with higher complication rates.

Conclusions:

  • Achieving adequate reduction and medial calcar support is critical for successful PHF fixation.
  • Surgeons should avoid varus reduction, ensure medial bone contact, limit proximal screw length to <45 mm, and maintain humeral offset within 6 mm.