Background:The purpose is based on anatomical basis, combined with three-dimensional measurement, to guide the clinical repositioning of proximal humeral fractures, select the appropriate nail entry point and angle, and simulate surgery.
Methods: 11 fresh cadaveric specimens were collected, the distance of the marked points around the shoulder joint was measured anatomically, and the vertical distance between the inferior border of the acromion and the superior border of the axillary nerve, the vertical distance between the apex of the humeral head and the superior border of the axillary nerve, the vertical distance between the inferior border of the acromion and the superior border of the anterior rotator humeral artery, and the vertical distance between the apex of the humeral head and the superior border of the anterior rotator humeral artery were marked on the 3D model based on the anatomical data to find the relative safety zone for nail placement.
Results:Contralateral data can be used to guide the repositioning and fixation of that side of the proximal humerus fracture, and uniform data cannot be used between male and female patients. For lateral nailing, the distance of the inferior border of the acromion from the axillary nerve (5.90±0.43) cm, range (5.3-6.9) cm, was selected for nailing along the medial axis of the humeral head, close to the medial cervical cortex, and the nailing angle was measured in the coronal plane (42.84±2.45)°, range (37.02°~46.31°), and in the sagittal plane (28.24±2.25)°, range ( 19.22°~28.51°). The nail was advanced laterally in front of the same level of the lateral approach point to form a cross-fixed support with the lateral nail, and the nail angle was measured in the coronal plane (36.14±1.75)°, range (30.32°~39.61°), and in the sagittal plane (28.64±1.37)°, range (22.82°~32.11°). Two pins were taken at the greater humeral tuberosity for fixation, with the proximal pin at an angle (159.26±1.98) to the coronal surface of the humeral stem, range (155.79°~165.08°), and the sagittal angle (161.76±2.15)°, with the pin end between the superior surface of the humeral talus and the inferior surface of the humeral talus. The distal needle of the greater humeral tuberosity was parallel to the proximal approach trajectory, and the needle end was on the inferior surface of the humeral talus.
Conclusion: Based on the anatomical data, we can accurately identify the corresponding bony structures of the proximal humerus and mark the location of the nail on the 3D model for nail placement, which is simple and practical to meet the relevant individual parameters.