Proximal humeral fractures: an understanding of the ideal plate positioning |
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Authors: | Pedro José Labronici Rodrigo Pires e Albuquerque Vinícius Schott Robinson Esteves Santos Pires Willian Dias Belangero José Sérgio Franco |
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Institution: | 1. Department of Orthopaedic Surgery, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil 2. Federal University of Minas Gerais, Avenida Professor Alfredo Balena, 190. Centro, Belo Horizonte, Minas Gerais, Brazil 3. Department of Orthopaedic Surgery, FCM/UNICAMP, Campinas, S?o Paulo, Brazil 4. Department of Orthopaedic Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract: | Purpose The present study aims to evaluate if the bicipital groove can be used as a parameter for ideal plate positioning in proximal humeral fixation applying locking compression plate. Method The authors questioned whether the bicipital groove can be used as a parameter for ideal plate positioning applying locking compression plate for proximal humeral fractures. A method using the bicipital groove as the main parameter was developed using computed tomography scan (CT-scan). Seventy shoulders presenting fracture absence were used to calculate proper plate positioning, allowing the largest area for locked screw placement into the humeral head. Intraclass correlation coefficient and Bland and Altman graphics calculated intra-observer reliability for CT-scan evaluation. Results All observers presented satisfactory plate positioning using this method. The mean differences for observers were close to zero, suggesting high interobserver reproducibility. A significant (p?<0.0001) intra-observer agreement existed for the three evaluators. Observer 2 agreement was the strongest (ICC?=?0.98), showing almost perfect reproducibility measurement, followed by observer 3 (ICC?=?0.84) with good reproducibility, and lastly observer 1 demonstrated moderate degree agreement (ICC?=?0.47). Conclusion Considering the CT-scan analysis, the bicipital groove can be used as a parameter for ideal plate positioning in proximal humeral fractures. This method demonstrated satisfactory intra-observer reproducibility. Adopting this method, longer and better distributed screw placement provides more stable fixation for proximal humeral fractures. |
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