The Anatomy Study Of The Proximal Humerus And Their Relevance In Fracture Treatment

ObjectiveTo assess the location of anterior humeral circumflex artery and axillary nerve based on the bony landmarks, and to provide the anatomic information for a safe approach on treatment of the proximal fracture.Method50 cadavers were included. The distance between the anterior humeral circumflex artery and the bony landmarks, and the distance from the axillary nerve to the incision and the bony landmarks were measured by using vernier calipe.All states were analyzed using SSPS software.ResultsIn our series, the distance between the inferior border of the medial acromion and the superior border of the anterior humeral circumflex artery was(5.1±0.2)cm(4.6-5.7cm),and the distance between the prominence of the lesser tuberosity and the superior border of the anterior humeral circumflex artery was(2.3±0.2)cm(1.8-3.0cm),and the width of the anterior humeral circumflex artery was(2.8±0.6)mm(2.2-5.3mm),and the angle between the anterior humeral circumflex artery and the vertical of the humerus was15°±4°(5°-22°), and the distance between the anterior-inferior border of the acromion and the superior border of the axillary nerve was (6.2±0.5)cm(4.8-7.0cm), and the distance between the prominence of the greater tuberosity and the superior border of the axillary nerve was (3.6±0.5)cm(2.7-6.1cm), and the angle between the axillary nerve and the vertical of the humerus was 22°±6°(8°-37°), and the width of the axillary nerve at the line between the anterior 1/3 and the lateral 1/3 deltoid muscle was (4.3±0.6)mm(3.0-5.5mm).ConclusionThe present study shows the safe zone above the anterior humeral circumflex artery and the axillary nerve,within the incision and the bony landmarks. By using the safe zone could avoid damaging the anterior humeral circumflex artery and the axillary nerve during the proximal humerus fracture operations. the area where below the inferior border of the medial acromion about 5.1cm and below the prominence of the lesser tuberosity about 2.3cm is the anterior humeral circumflex artery. Therefore necessary reduction manoeuvres before osteosynthesis should be conducted with extreme care in order to preserve the anterior humeral circumflex artery. If the transdeltoid lateral approach is perform, the axillary nervethe should be took care not to be damaged which crosses the area distal from the anterior-inferior border of the acromion 6.2cm and distal from the prominence of the greater tuberosity 3.6cm .The proximal humeral Anatomic study for the proximal humerus locking plate modifyingObjectiveTo study the structure of the proximal humeral anatomy to modify the proximal humerus locking plate,for enhancing the stability of the proximal humeral fractures fixation.Method50 cadavers were included.The length and the width and the height of the greater tuberosity and the lesser tuberosity of the proximal humerus were measured by using vernier calipe.All states were analyzed using SSPS software. ResultsIn our series,the upper width of the greater tuberosity of the proximal humerus was (2.8±0.2)cm(2.4-3.3cm),and the lower width of the greater tuberosity of the proximal humerus was(3.3±0.2)cm(2.7-3.7cm),and the height of the greater tuberosity of the proximal humerus was(2.7±0.3)cm(2.1-3.4cm), and the width of the lesser tuberosity of the proximal humerus was(2.0±0.4)cm(1.1-2.5cm),and the height of the lesser tuberosity of the proximal humerus was(1.6±0.3)cm(0.9-2.2cm), and the distance between he greater tuberosity and the lesser tuberosity of the proximal humerus was(1.0±0.2)cm(0.8-1.4cm).ConclusionThe study of the anatomy of the greater tuberosity and the lesser tuberosity of the proximal humerus has show that the locking plate does not always suit the anatomy of the proximal humerus,and the fractures of the the greater tuberosity and the lesser tuberosity can not be fixted directly by the locking plate strongly.The area on the the greater tuberosity of the proximal humerus where the the upper width was about 2.8cm and the lower width was about 3.3cm and the height was about 2.7cm and the area on the lesser tuberosity of the proximal humerus where the width was about 2.0cm and the height was about 1.6cm can be placed by plate to fix the fractues strongly ,with avoiding damaging the rotator cuff and artery supply of the proximal humerus .It has reference value for modifying the proximal humerus locking plate. the width of the lesser tuberosity of the proximal humerus was(2.0±0.4)cm(1.1-2.5cm),and the height of the lesser tuberosity of the proximal humerus was(1.6±0.3)cm(0.9-2.2cm)...