THE PROXIMAL HUMERAL LOCKING PLATE POSITIONING TO THE PECTORALIS MAJOR TENDON IN ACHIEVING THE PROPER CALCAR SCREW LOCATION
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Abstract
Introduction: The optimal positioning of the proximal humeral locking plate in the surgical treatment of proximal humeral fractures remains a topic of ongoing investigation and refinement.
Objectives: The main objective of the study is to find the proximal humeral locking plate positioning to the pectoralis major tendon in achieving the proper calcar screw location.
Material and methods: This prospective observational study was conducted at Mehar General Hospital, Haripur, KPK Pakistan from June 2022 to June 2023. Data were collected from 20 patients undergoing surgery. A total of 20 patients diagnosed with proximal humeral fractures underwent surgical treatment using a locking plate fixation technique. All surgeries were performed by experienced orthopedic surgeons specializing in shoulder and upper extremity trauma. The proximal humeral locking plate was positioned under direct visualization with reference to the pectoralis major tendon.
Results: Data were collected from 20 patients according to criteria. Mean age of the patients were 45.09± 6.2 years. There were 65% male and 35% female patients. 60% patients are with displaced fractures and 40% with non-displaced fractures. 90% of the patients shows Accuracy of Calcar Screw Placement. The Chi-square test revealed a statistically significant association (p < 0.05) between calcar screw location and the analyzed variable. Pearson correlation analysis indicated a significant correlation between plate positioning, screw location, and clinical outcomes, suggesting a potential relationship between these factors in influencing treatment effectiveness.
Conclusion: It is concluded that aligning the proximal humeral locking plate with the pectoralis major tendon facilitates accurate calcar screw placement, enhancing biomechanical stability and surgical outcomes in proximal humeral fracture fixation.
References
2. Butler, Matthew A., et al. "Establishing the Appropriate Position of Proximal Humerus Locking Plates: A Cadaveric Study of Five Plating Systems and Their Anatomic Reference Measurements." Shoulder & Elbow, vol. 10, no. 1, 2017, pp. 40-44, https://doi.org/10.1177/1758573217704816.
3. Kim BS, Kim DH, Song HS, Min BW, Bae KC, Cho CH. Is the pectoralis major tendon a reliable reference for restoration of humeral length with fracture hemiarthroplasty? J Shoulder Elbow. 2018;27:e45–9.
4. Joseph HD, Michael DE, Joseph WG, Betsey KB, David JW, Edward DA. Pectoralis major tendon insertion anatomy and description of a novel anatomic reference. J Surg Orthop Adv. 2018;27:39–41.
5. Russo R, Guastafierro A, Pietrolouogo LR. A morphovolumetric study of head malposition in proximal humeral fractures based on 3-dimensional computed tomography scans: a control volume theory. J Shoulder Elbow Surg. 2018;27:940–9.
6. Qiang M, Jia X, Chen Y, Zhang K, Li H, Jiang Y, Zhang Y. Assessment of screw length of proximal humerus internal locking system (PHILOS) plate for proximal humerus fractures using three-dimensional imputed tomography can. Med Sci Monit. 2018;24:158–65.
7. Jabran A, Peach C, Ren L. Biomechanical analysis of plate system for proximal humerus fractures: a systematic literature review. Biomed Eng Online. 2018;17:47.
8. Shah KN, Sobel AD, Paxton ES. Fixation of a proximal humerus fracture using a polyaxial locking plate and endosteal fibular strut. J Orthop Trauma. 2018;32:S8-9.
9. Kimmeyer M, Schmalzl J, Rentschler V, Schieffer C, Macken A, Gerhardt C, Lehmann LJ. Correct positioning of the calcar screw leads to superior results in proximal humerus fractures treated with carbon-fibre-reinforced polyetheretherketone plate osteosynthesis with polyaxial locking screws. J Orthop Traumatol. 2023 Oct 10;24(1):54. doi: 10.1186/s10195-023-00733-3. PMID: 37816859; PMCID: PMC10564686.
10. Ziegler P, Maier S, Stuby F, Histing T, Ihle C, Stöckle U, Gühring M. Clinical Outcome of Carbon Fiber Reinforced Polyetheretherketone Plates in Patients with Proximal Humeral Fracture: One-Year Follow-Up. Journal of Clinical Medicine. 2023 Oct 31;12(21):6881.
11. Katthagen JC, Ellwein A, Lutz O, Voigt C, Lill H. Outcomes of proximal humeral fracture fixation with locked CFR-PEEK plating. European Journal of Orthopaedic Surgery & Traumatology. 2017 Apr;27:351-8.
12. Kimmeyer M, Schmalzl J, Rentschler V, Jessen M, Gerhardt C, Lehmann LJ. Functional results and unfavorable events after treatment of proximal humerus fractures using a new locking plate system. BMC Musculoskeletal Disorders. 2023 Jan 24;24(1):63.
13. Ziegler P, Maier S, Stöckle U, Gühring M, Stuby FM. The Treatment of Proximal Humerus Fracture Using Internal Fixation With Fixed-angle Plates: A Randomized Controlled Study Comparing Carbon Fiber Reinforced Polyetheretherketone With Titanium. Deutsches Ärzteblatt International. 2019 Nov;116(45):757.
14. Chen JL, Chang FC, Lin SJ, Chuang PY, Peng KT, Huang KC, Huang TW. The outcome of surgical management of proximal humeral fractures using locking plates: comparison between locking plates with different geometry. Journal of Shoulder and Elbow Surgery. 2018 Dec 1;27(12):2159-66.
15. Schliemann B, Hartensuer R, Koch T, Theisen C, Raschke MJ, Kösters C, Weimann A. Treatment of proximal humerus fractures with a CFR-PEEK plate: 2-year results of a prospective study and comparison to fixation with a conventional locking plate. Journal of shoulder and elbow surgery. 2015 Aug 1;24(8):1282-8.
16. Hak DJ, Fader R, Baldini T, Chadayammuri VB. Locking screw-plate interface stability in carbon-fibre reinforced polyetheretherketone proximal humerus plates. International Orthopaedics. 2017 Sep;41:1735-9.
17. Liu J, Cui P, Wu X, Han L, Wang G, Dong J. Short‐term clinical outcome of dual plate fixation in the treatment of proximal Humerus fractures with calcar comminution. Orthopaedic Surgery. 2023 Aug;15(8):1990-6.
18. Katthagen JC, Schwarze M, Warnhoff M, Voigt C, Hurschler C, Lill H. Influence of plate material and screw design on stiffness and ultimate load of locked plating in osteoporotic proximal humeral fractures. Injury. 2016 Mar 1;47(3):617-24.
19. Theivendran K, Arshad F, Hanif UK, Reito A, Griffin X, Foote CJ. Carbon fibre reinforced PEEK versus traditional metallic implants for orthopaedic trauma surgery: A systematic review. Journal of clinical orthopaedics and trauma. 2021 Dec 1;23:101674.
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Dr. Muhammad Adeel
Assistant Professor Orthopedic, Ayub Medical College and Ayub Teaching Hospital Abbottabad.
Muhammad Ali Usman
Assistant Professor of Orthopaedics, Abbottabad International Medical Institute Abbottabad
Muhammad Basharat
Assistant Professor Women Medical College Abbottabad
Dr Muhammad Tayab
PGR Orthopaedic B Unit ATH Abbottabad