Referencing the pectoralis major tendon for humeral stem height placement in reverse shoulder arthroplasty for fracture |
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| Institution: | 1. Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Icahn School of Medicine at Mount Sinai, New York, NY, USA;3. Mayo Clinic, Rochester, MN, USA;1. The Shoulder Center Research, Baylor Scott & White Research Institute, Dallas, TX, USA;2. Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA;3. Upper Limb Unit, F Miulli Hospital, Acquaviva Delle Fonti, Italy;1. Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA;2. Department of Orthopaedics and Traumatology, Villa del Sole Clinic, Catanzaro, Italy;1. Massachusetts General Hospital, Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA;2. New England Baptist Hospital, Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA, USA;3. Tufts Medical Center, Department of Orthopaedic Surgery, Tufts University School of Medicine Boston, MA, USA;1. Suncoast Orthopaedic Surgery and Sports Medicine, Venice, FL, USA;2. Foundation for Orthopaedic Research and Education, Tampa, FL, USA;3. Department of Medical Engineering, University of South Florida, Tampa, FL, USA |
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| Abstract: | BackgroundProximal humerus fractures remain a challenging problem, and reverse total shoulder arthroplasty (RSA) has demonstrated reliable outcomes in fracture applications. Despite this, guidelines for placement of the humeral component are lacking.MethodsTwelve cadaveric shoulders (6 cadaveric torsos) were utilized. An onlay RSA stem was placed with the lateral potion of the humeral cup positioned at the level of the greater tuberosity. Measurements were taken from the top of the pectoralis major tendon to the top of the humeral stem. A separate computer-aided analysis was conducted analyzing the height of an RSA humeral stem and an RSA humeral stem with a cup using values extrapolated from prior data.ResultsThe average distance from the top of the pectoralis to the top of the humeral stem was 4.0 cm (3.4 cm to 4.8 cm) with a standard deviation of 4.1. The humeral cup added an average of 9.1 mm. Computer-aided design data demonstrated the average height of the humeral stem was 3.9 cm above the superior aspect of the pectoralis tendon, and the average height with the humeral cup added was 4.8 cm.ConclusionBoth the cadaveric and computer-aided design data demonstrated a similar height for both the distances from the superior portion of the pectoralis to the superior aspect of an onlay RSA stem and the humeral cup. The measurement from the humeral cup may allow for translational use with inlay RSA humeral stems. This study demonstrates the superior border of the pectoralis major tendon to be a reliable landmark in RSA humeral stem placement.Level of evidenceLevel IV; Cadaveric Study |
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