Repositioning of the humeral tuberosities can be guided by pectoralis major insertionReport as inadecuate

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Strategies in Trauma and Limb Reconstruction

, Volume 9, Issue 3, pp 127–131

First Online: 19 December 2014Received: 20 February 2014Accepted: 05 December 2014


In complex proximal humerus fractures, positioning of the tuberosities can be a challenge. This study demonstrates the constant angle between the pectoralis major PM and the medial lip of the bicipital groove BG on the horizontal axial plane. This angle can be used to determine the rotation, as well as the positioning of the tuberosities, when planning a hemiarthroplasty or a reconstruction. Thirty-one shoulder MRIs were reviewed by three independent observers. The measurements were taken by superposing the axial cut of the proximal humerus, at the level of the distal bicipital groove, and the cut at the top of the PM insertion. By aligning the centers of rotation, we could determine the arcs of rotation between the insertion of the PM and the lips of the medial and lateral bicipital groove MBG and LBG. Both angles were compared in terms of reliability, reproducibility, and precision. The mean PM–MBG angle was 3.7° standard deviation SD 14.7° and 27.4° SD 14.4° for the PM–LBG angle. We obtained good and very good intra-class correlation coefficient ICC results for inter- 0.675 and intra-observer 0.793 reliabilities on the medial angle, plus excellent results for the lateral angle inter-observers 0.962 and intra-observer 0.895. This study demonstrates that the repositioning of humeral tuberosities can be guided by pectoralis major insertion. This will help achieve proper positioning of the metaphysis in relation to the diaphysis during surgery for complex proximal humerus fractures.

KeywordsShoulder Pectoralis major Bicipital groove MRI Tuberosity Proximal humerus fracture  Download fulltext PDF

Author: Alec Cikes - Étienne Trudeau-Rivest - Fanny Canet - Jonah Hébert-Davies - Dominique M. Rouleau


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