Position of calcar screws in proximal humerus X-Rays in a peruvian hospital
Keywords:
proximal humeral fractures, osteosynthesis, bone plates, bone screws, bone scan.Abstract
Introduction: Calcar screws remain under the humeral head in some patients when osteosynthesis is performed with locking systems. This favors displacement of the head in varus and failure of osteosynthesis.
Objective: To determine the relationship between the calcar distance and the diameter of the humeral head, the humeral isthmus or height, in cases where the screws are under the head of the humerus.
Methods: Patients with probable proximal humerus fracture were studied, from April to December 2022, in the Orthopedics Service of Rebagliati Hospital in Lima, Peru. Digital preoperative with PHILoS plate template was planned. The calcar distance, humeral head and isthmus diameter were measured, and height was recorded. The average calcar distance and the percentage of cases with a calcar screw under the head of the humerus were obtained. The relationship between measurements was determined using linear regression. Results: One hundred one patients were included. The average calcar distance was 0.55 ± 4.51 mm and it was lower in women (-0.67 ± 3.90 mm). The calcar screw remained under the humeral head in 38 patients (43.18%). A direct linear relationship was reached between the calcar distance and the diameter of the humeral head (p = < 0.001), but not with height (p = 0.691) or diameter of the isthmus (p = 0.970).
Conclusions: In most patients the calcar screw remained under the humeral head. Calcar distance was directly related to the diameter of the humeral head, but it was not so to the height or diameter of the humeral isthmus.
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References
Roux A, Decroocq L, El Batti S, Bonnevialle N, Moineau G, Trojani C, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res. 2012;98(6):715-9. DOI: https://doi.org/10.1016/j.otsr.2012.05.013
Departamento de Ortopedia y Traumatología, Hospital Nacional Edgardo Rebagliati Martins. Libros de Ingresos de los servicios del Departamento de Ortopedia y Traumatología. Lima, Perú; 2022.
Pavone V, Vescio A, Denaro R, Costa D, Caruso VF, Condorelli G, et al. Use of different plate implants for surgical treatment of proximal humerus fractures in adults: a systematic review. Acta Biomed. 2021;92(4):e2021198. DOI: https://doi.org/10.23750%2Fabm.v92i4.11394
Gardner MJ, Weil Y, Barker JU, Kelly BT, Helfet DL, Lorich DG. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21(3):185-91. DOI: https://doi.org/10.1097/bot.0b013e3180333094
Padegimas EM, Nicholson TA, Chang G, Hebert-Davies J, Namdari S. Outcomes of open reduction and internal fixation of proximal humerus fracture dislocations. J Shoulder Elbow Surg. 2021;30(10):2331-5. DOI: https://doi.org/10.1016/j.jse.2021.01.025
Mehta S, Chin M, Sanville J, Namdari S, Hast MW. Calcar screw position in proximal humerus fracture fixation: Don’t miss high! Injury. 2018;49(3):624-9. DOI: https://doi.org/10.1016%2Fj.injury.2018.02.007
Padegimas EM, Zmistowski B, Lawrence C, Palmquist A, Nicholson TA, Namdari S. Defining optimal calcar screw positioning in proximal humerus fracture fixation. J Shoulder Elbow Surg. 2017;26(11):1931-7. DOI: https://doi.org/10.1016/j.jse.2017.05.003
Zhang Q, Shi LL, Ravella C, Koh JL, Wang S, Liu C, et al. Distinct proximal humeral geometry in chinese population and clinical relevance. J Bone Joint Surg Am. 2016;98(24):2071-81. DOI: https://doi.org/10.2106/jbjs.15.01232
Asgari S, Luo Y, Akbari A, Belbin GM, Li X, Harris DN, et al. A positively selected FBN1 missense variant reduces height in Peruvian individuals. Nature. 2020;582(7811):234-9. DOI: https://doi.org/10.1038/s41586-020-2302-0
Zhang X, Huang J, Zhao L, Luo Y, Mao H, Huang Y, et al. Inferomedial cortical bone contact and fixation with calcar screws on the dynamic and static mechanical stability of proximal humerus fractures. J Orthop Surg Res. 2019;14(1):1. DOI: https://doi.org/10.1186%2Fs13018-018-1031-7
Bouliane M, Silveira A, Al Eidan AJ, Heinrichs L, Kang SH, Sheps DM, et al. Factors associated with maintaining reduction following locking plate fixation of proximal humerus fractures: a population-based retrospective cohort study. JSES Int. 2020;4(4):724-9. DOI: https://doi.org/10.1016%2Fj.jseint.2020.07.022
Wang JQ, Zhao YM, Jiang BJ, Ke Cr. A nomogram for predicting reduction loss risk after locking plate fixation for proximal humeral fractures. Injury. 2021;52(10):2947-51. DOI: https://doi.org/10.1016/j.injury.2021.07.041
Mendoza I, González Á, Jacobo G, Castañeda A, Valenzuela J. Análisis de los elementos principales en el diseño de placas de bloqueo en una fractura de 2-partes del cuello quirúrgico del húmero utilizando MEF y análisis estadístico. Materia. 2018;23(4). DOI: https://doi.org/10.1590/S1517-707620180004.0556
Lee JS, Kim JH, Kim KG, Yoon YC. Effect of calcar screw in locking compression plate system for osteoporotic proximal humerus fracture: a finite element analysis study. Biomed Res Int. 2022;2022:1268774. DOI: https://doi.org/10.1155%2F2022%2F1268774
Xu J, Zhan S, Ling M, Jiang D, Hu H, Sheng J, et al. How can medial support for proximal humeral fractures be achieved when positioning of regular calcar screws is challenging? Slotting and off-axis fixation strategies. J Shoulder Elbow Surg. 2022;31(4):782-91. DOI: https://doi.org/10.1016/j.jse.2021.08.033
Jabran A, Peach C, Ren L. Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review. Biomed Eng Online. 2018;17(1):47. DOI: https://doi.org/10.1186%2Fs12938-018-0479-3
Bai L, Fu Z, An S, Zhang P, Zhang D, Jiang B. Effect of calcar screw use in surgical neck fractures of the proximal humerus with unstable medial support: A biomechanical study. J Orthop Trauma. 2014;28(8):452-7. DOI: https://doi.org/10.1097/bot.0000000000000057
Ponce BA, Thompson KJ, Raghava P, Eberhardt AW, Tate JP, Volgas DA, et al. The role of medial comminution and calcar restoration in varus collapse of proximal humeral fractures treated with locking plates. J Bone Joint Surg Am. 2013;95(16):e113(1-7). DOI: https://doi.org/10.2106/jbjs.k.00202
Burke NG, Kennedy J, Cousins G, Fitzpatrick D, Mullett H. Locking plate fixation with and without inferomedial screws for proximal humeral fractures: a biomechanical study. J Orthop Surg (Hong Kong). 2014;22(2):190-4. DOI: https://doi.org/10.1177/230949901402200215
Shin MJ, Kim H, Kim DM, Park D, Jeon IH, Koh KH. Role of inferomedial supporting screws for secondary varus deformity in non osteoporotic proximal humerus fracture: A biomechanical study. Arch Orthop Trauma Surg. 2021;141(9):1517-23. DOI: https://doi.org/10.1007/s00402-020-03627-9
Zeng LQ, Zeng LL, Jiang YW, Wei HF, Zhang W, Chen YF. Influence of medial support screws on the maintenance of fracture reduction after locked plating of proximal humerus fractures. Chin Med J (Engl). 2018;131(15):1827-33. DOI: https://doi.org/10.4103%2F0366-6999.237396
Oppebøen S, Wikerøy AK, Fuglesang HF, Dolatowski FC, Randsborg PH. Calcar screws and adequate reduction reduced the risk of fixation failure in proximal humeral fractures treated with a locking plate: 190 patients followed for a mean of 3 years. J Orthop Surg Res. 2018;13(1):197. DOI: https://doi.org/10.1186%2Fs13018-018-0906-y
Jabran A, Peach C, Zou Z, Ren L. Biomechanical comparison of screw-based zoning of PHILOS and Fx proximal humerus plates. BMC Musculoskelet Disord. 2018;19(1):253. DOI: https://doi.org/10.1186%2Fs12891-018-2185-5
Wang H, Liu Y, Wang D, He Y, Yao P, Lu T, et al. Predictive indicators for complications of proximal humerus fractures treated with locking plate or intramedullary nail fixation. Orthop Surg. 2022;14(9):2109-18. DOI: https://doi.org/10.1111%2Fos.13421
